Employment and Support Allowance and Work Capability Assessments

Anne Marie Morris Excerpts

Thursday 5th February 2015 Westminster Hall

[Anne Marie Morris (Newton Abbot) (Con)]

It is a pleasure to serve under your chairmanship, Mr Walker.

I want first to give the Government credit for making great steps forward with the challenges and issues we are discussing, and in supporting individuals with getting into work. That is important, and it makes people feel worth while and fulfilled. Clearly, however, no system is perfect, and the job of a Select Committee is to consider not what works but what does not, and to get it put right. That inevitably sets the focus.

There has clearly been a fair amount of change in the Government’s approach to the work capability assessment. The Work and Pensions Committee was right to point out that when there is a significant amount of change, it must be managed. I am sure that I share with other hon. Members the experience of dealing with constituents who have found that in practice some of the changes have not worked as well as they might.

One of the main changes was the move from asking someone what illness they had to asking them what, functionally, they could do. That was significant, and moving to the new assessment would inevitably be a challenge. Clearly, however, it was a move in the right direction. Just having a particular condition does not mean ex post facto and for ever being unable to work. I understand why the Government moved in that direction, and I think they were right.

As always, the challenge is in the implementation. That implementation challenge is probably in two parts. One is the fact that the process is not quite right, which was largely what the Work and Pensions Committee, of which I am a member, discussed. The other is the people involved in the system and the way they apply it. That is partly to do with culture change and partly to do with training; it is about getting used to a new way of doing things. There were always going to be challenges, but as the hon. Member for Aberdeen South (Dame Anne Begg), who is a wonderful Chair of the Select Committee, made clear, it is right that people with disabilities and health problems should receive all the help they need to get into the world of work.

Dr Litchfield made an interesting comment in his last report—that we need a system that is not only fair but seen to be fair, which is quite a challenge. It will be even more of a challenge for the Government given the unhappy experiences of many of our constituents with Atos. One of the fundamental challenges, to which the hon. Lady referred, is the new functional test. As has been said, it raises issues for two groups: people with mental health problems and people with fluctuating conditions.

The report raised another issue, which the hon. Lady also mentioned—the challenge of operational issues and the proper management of appointments, to prevent people from being notified of them after the time they are set for and then being criticised as a no-show, or not being told about cancellations in time. Some of my constituents who have a disability and use a wheelchair have been invited to appointments on the first floor of a place with no lift. There are challenges in improving the process, and, having seen some of what went wrong, we live in hope that the new provider will have more ability to put things right. There are some things that should be fairly straightforward.

The hon. Lady made interesting comments about categorisation, and I agree with many of them. The figures are interesting—they show that between 2009 and 2013, the number of people found fit for work fell. What does that tell us? In percentage terms, the fit-for-work group fell in numbers, the WRAG fell and the support group went up. Surely that means that more people are in the support group and are being helped, or that more people have been identified as requiring help and are being supported, which seems to me to be a good thing. If the fit-for-work group is falling in numbers, that implies that people who were wrongly being asked to do the impossible are no longer being asked to do the impossible. However, I share Chair of the Select Committee’s concerns about the WRAG. It is unfortunate that we pronounce the acronym like a piece of cloth; it is a mixed bag, and I entirely support the Committee’s recommendation that we look at unpicking it. Putting individuals with absolutely no prospect of improving into that group does not seem right.

As our Chair identified, the Work and Pensions Committee put forward a key recommendation of a fundamental redesign. The Government’s response was that they wanted to focus on the introduction of the new provider rather than get involved in a complete reconfiguration at this point. Given the timeline and the fact that Atos decided to stand aside before the end of its contract, I have some sympathy with that approach. A new provider cannot come in without being properly brought up to speed. If we start trying to change the process, we will have to go through all sorts of reports, protocols and so on, whereas if we work with a new provider and discuss what went wrong, we can effect change without having to change some of the rules fundamentally. It seems to me that that is the right thing to do.

Part of the challenge of a fundamental redesign, which I support in the longer term, is that when individuals are in the system, we are trying to assess two things: their health inabilities and constraints, and how to help them into work. Although the Government were right to try to combine all the many systems that we had in the past into one, there is clearly a challenge with regard to incapacity. I am not clear on whether the best way forward is, as the Select Committee recommended, to separate out the two and have a new system, front-ended to look specifically at the health incapacities, or whether it is to improve training to try to make the two pieces work better together. I am hopeful, however, that under the new contract we might consider changes that will enable us to answer that question.

As the report sets out, in addition to the proposal of a fundamental redesign, the Select Committee raised a number of issues relating to particular aspects of the scheme. The first was the standard of service on bookings, the operation of the system and the challenge of having enough people who understand mental health and have mental health experience. That is all crucial. The Government recognised those issues and have undertaken to increase the number of health care professionals who specialise in mental health. They recognise that it is crucial that those making decisions understand fluctuating conditions, and they will look at ensuring that the new provider’s training and induction takes that on board. The Government also took on board the need to be more aware of and better understand disability issues, so I think that things are going to get better.

The second short-term change that the Work and Pensions Committee recommended was on communication. The Chair of the Committee made the point very well, and the detail in the report was spot on. The problem was not only that the content of the language used on the telephone, and of the forms and letters, was unclear and misleading—the information that was really required was not there—it was also about the tone. The tone of a letter is important and makes a difference to how the information is taken in. To their credit, the Government have said that they are reviewing that.

The Select Committee recommended a number of short- term changes. Our Chair referred to some of them, and I will certainly not take Members on the same magical mystery tour again, because that would not be a helpful use of our time. Nevertheless, one short-term challenge does require attention: a more sensitive application of the descriptors “reliably”, “repeatedly” and “safely”. Those are quite difficult words. For me, the challenge is how we test them, because we clearly cannot just use a snapshot. We cannot just look at a GP’s letter; we need to find a way to unpick whether the functionality or performance that is required can be performed reliably, repeatedly and safely.

I also want to discuss the contribution of evidence to assessment decisions. The Chair of the Select Committee referred to the extent to which GPs are helpfully involved in the process and the evidence that they should provide. I am concerned that if information needs to be provided, it must be clear to individuals whether they need to take the initiative to get a letter from the GP or whether the decision makers will get it. There also seems to be a postcode lottery regarding the costs of GP reports. In some areas they are free, but in others they are not. That does not seem right or fair.

There is also the issue of trying to help doctors understand how they must write those letters, because they are not about somebody’s medical condition. Unless they can write a letter that links the medical condition to its effect on functionality, it is not particularly helpful. There will be those who say that that is not really a GP’s job, but I think that a GP is concerned to ensure that the best outcomes are available to his or her patients. That is an important point.

Government action is still needed, and in conclusion I want to indentify five points that require a specific review. First, one of the most important findings of the report was that the work-related activity group needs to be looked at carefully, because at the moment it seems to be a mixture of too many people with too many challenges. Secondly, we must ensure that the Government monitor the new provider very carefully. How does the Minister propose to do that, and what links has he made between his plans and the concerns raised by the Work and Pensions Committee?

Thirdly, it is important to consider how we deal with the particular needs of those with mental health problems and learning disabilities. I have not dwelt on this point so far, because the Chair of the Select Committee discussed it, but my fourth priority is mandatory reconsideration. It is quite challenging when people do not know when a final decision is going to be made, and that creates all sorts of distress. The Government’s response was to say, “No, we don’t need to do that, but we can give you some statistics,” which was not as helpful an answer as it might have been.

Finally, we must look at how we continue to review the interaction between the health challenge and the employment support challenge so that, ultimately, we can take a view on whether we need to re-engineer the system. We must separate out the two decisions. First, what is the health challenge and how do we meet it? Secondly, how do we deal with the specific employment support that is required?

Those are my thoughts. The Select Committee has done a good job of unpicking the issues that must be addressed. In the written response to the report, the Minister said that on a number of matters he would give us his reply in due course, potentially in a Westminster Hall debate, so we are looking forward to seeing whether we get replies to some of the questions that we asked.