Welfare Reform Bill

Baroness Grey-Thompson Excerpts

Wednesday 16th November 2011 Grand Committee

[Baroness Thomas of Winchester]

That will be helpful.

[Baroness Grey-Thompson]

My Lords, I thank all noble Lords for their contributions on this group of amendments and the Minister for his comments. I feel that I am not knocking at a completely shut door. However, I still believe that those who should be allowed to be consulted should be made more explicit in the Bill. I also accept that, in some cases, collecting additional evidence from the claimant’s medical practitioner may be unnecessary as the decision may be clear-cut. I think the noble Baroness, Lady Thomas of Winchester, for highlighting the fact that information should be used, not just collected. That has given me plenty of food for thought on my future wording.

There has been strong support for the use of the best evidence possible so that we can arrive at the right decision for the disabled people concerned and be effective in the use of public money. To not take medical evidence into account or use appropriate support advocacy, as mentioned by the noble Lords, Lord Wigley and Lord German, would be a false economy. However, we are still missing something.

As regards the financial cost and the cost in time of an appeals process—not to mention the stress that that will cause to the great number of people who will have to go through it and the fact that it could block up the system—I would much rather the money go into people’s pockets than into the process. On the testing process, it does not matter whether you ask 20 or 200 questions, if the claimant is not able to give the best answer or the right answer, or the answers are not correctly linked together in the process, you will not get to the right decision and will be left in a situation where there is a huge number of appeals. I am not asking for more money to be spent; only that it is spent in the right place.

The Minister referred to the correct training for assessors to ensure that they reach the right standard. That is incredibly important. However, I am not convinced that we are yet in the right place; there is still much work to be done. I shall return to this issue at a later stage. However, I beg leave to withdraw the amendment.

Amendment 86ZZZUA withdrawn.

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[The Earl of Listowel]

I suspected it might not be. For people with fluctuating conditions, where there is a likelihood of their going back on repeated occasions, perhaps one could sort out within a particular group individuals who would benefit from having regular contact with the same person. In the spirit of co-production, some individuals who are going to be assessed on a repeated basis may perhaps like to choose the person they deal with. However, as I say, I do not know how it works in practice at the moment so this may be by the by.

On listening to this debate, the question of the supervision which takes place in the social care arena seems to be pertinent. I am grateful to the Minister for making it possible for a social worker to visit the officials working on this and to discuss matters of supervision. In social care it is very important for front-line staff to receive quality supervision on a regular basis for three purposes: first, to check that they are doing the right job; secondly, to check that they are receiving the right continual professional development; and, thirdly, to ensure that they are not responding inappropriately to the clients.

On the third purpose, we all come to life with our experiences, and some assessors may find it difficult to work with particular clients who rub them up the wrong way. They need to be able to go to their supervisor and say, “Look, I feel really uncomfortable working with this person. I am not sure it is actually anything to do with them. Can you help me to sort this out?” They need a sounding board, if you like. That is one aspect.

On the continuing professional development side, this is a training aspect to check that they are continually building on their understanding of, let us say, autism. They will start from a point of ignorance but, in the course of years of experience, they will learn more and more. They are helped to do so and their supervisor ensures that they get the opportunities for that learning and enrichment. It is a draining job and the people doing it need to be recognised, supported and enriched. I have covered those three points but, as I say, I am not sure it is pertinent.

The proposal for a trial arrangement might allow an opportunity for us to find the most effective kind of supervision we can afford to provide and where there are opportunities to build continuity of relationship with clients.

I have an amendment later in the Bill which relates to how one manages the system and the culture in this area. If the people at the very top of some of these organisations had experience of social care—if one could be confident that there was a senior social worker at the top of the Jobcentre Plus arrangements, or whatever—they would have the necessary insight and the understanding to help people on the front line who will need a system of this kind to assist them in working with vulnerable adults. In that way, even with limited resources, the best outcomes could be achieved in the circumstances.

However, I will come to that amendment later. I look forward to the Minister’s reply.

[Baroness Grey-Thompson]

My Lords, I support the noble Baroness, Lady Campbell of Surbiton, and this amendment is also in my name. It is vital to ensure that the new framework is right, and this amendment gives me some comfort in what is a very difficult time for a huge number of disabled people. The noble Baroness, Lady Howe of Idlicote, mentioned time. That time is required.

If someone has a health condition that is likely to improve, or a newly acquired impairment to which they are likely to adapt, no one would argue that the costs might not change over time and that there should not be a reassessment. For example, the costs of someone who is a lower leg amputee will be very different in the first 18 months or two years after the amputation from what they may be 20 years later when they have adapted to it. However, when someone has a health condition or impairment that is unlikely to change and the costs are likely to remain the same, it does not make sense to keep sending them for more face-to-face assessments. For people in this situation it should be enough to confirm with the claimant’s healthcare professionals that their condition is unchanged. I feel very strongly about this because the following claimant told the MS Society how she feels about the prospect of face-to-face assessments. Many like her find this process very strange given that so much is known about the condition, including that it will only get worse and not better. When such claimants have to talk to a stranger about some very intimate details of their life it can have a devastating effect on them. The claimant said:

“I am already dreading the day when I have to sit in front of someone and explain myself to them … When I am already seeing a neurologist and a whole team of people who help me to try and live as best I can with MS … This is just not fair in my eyes. … Shame on the people who have come up with these changes which once again affect real people who have no choice but to try and live with this illness”.

[Baroness Lister of Burtersett]

My Lords, I wish to speak briefly in support of the hobby horse of the noble Baroness, Lady Campbell of Surbiton, which we should take seriously. I was struck by what she said about how a trial period in which disabled people’s organisations were involved could do a lot to restore confidence in the system. I am sure that I am not the only noble Lord who has been struck by the e-mails, letters and faxes that I have received, which demonstrate that that confidence is at rock bottom. There has been a catastrophic loss of confidence. The noble Baroness is offering the Government perhaps not an olive branch, because that suggests that a war is going on, but an opportunity—I suggest that the Government would do well to grasp it—to listen to what is being said, accept this amendment with its trial period and involve disabled people’s organisations. That could go a long way to restore confidence in this system.

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[Baroness Campbell of Surbiton]

My Lords, I am also extremely supportive of this amendment. It is a government misuse of the social model to withdraw support by saying that if you have a decent wheelchair-adapted house and car your disability goes away. That was quoted to me by a DWP civil servant as a social model assessment. That is exactly why I tabled an amendment on social model assessment—so that we can teach assessors what the social model really means.

The noble Baroness, Lady Thomas, is absolutely right. If I were assessed today, I would probably be taken off DLA. I have my wheelchair, my adapted house, my car and some personal assistance. However the cost of maintaining that is absolutely phenomenal. My disability has gone away; it is away today. I feel equal to all who are here but tonight it might be different. Therefore, I am absolutely in favour of placing this in the Bill. It is a perverse incentive to account for aids by means-testing. It means that people might stop using their electric wheelchairs and adapted cars to get the benefit. They might hide them in the garage or swimming pool. Apparently people put their cars there to hide them from the taxman. As noble Lords can see, I am very supportive of this amendment.

[Baroness Grey-Thompson]

My Lords, I also support the noble Baroness, Lady Thomas of Winchester. When I first looked at this area, I found it quite confusing and some of it not very simple to understand. Some aids and adaptations are taken into account for the assessment. For example, for the mobility component, any aid that the person can use to assist them in walking is taken into account. However, someone who can self-propel a wheelchair will qualify because they are still unable, or virtually unable, to walk.

I declare an interest as a wheelchair user and someone who spends considerable time making sure that I can get the right aids and equipment for me to live as normal a life as possible. As the noble Baroness, Lady Campbell of Surbiton, has said, you try to get as much independence as possible. For me, it is about getting a small chair that means I can fit into every lift in this building, which is a challenge when they are all built into the various chimney stacks; and one that is light enough to push for more than 50 metres, which does not get you very far in your Lordships’ House on the very expensive carpet that we have here. I also need to get it in and out of my car. I spend a lot of time making sure that equipment is right for me but I could easily buy a chair with wheels that are 16 inches in diameter, rather than 11 inches, and that weighs 30 kilos instead of four and a half. That would change my impairment considerably but I want to be as independent as possible. Those aids and adaptations make my life easier but they do not stop the patronising attitude that is out there. They do not stop the barriers.

I also want to encourage disabled people to be as fit and healthy as possible but we could be in a situation where we prevent people exercising and doing physical activity because they are penalised for doing so. Again, in my case, I spend several hundred pounds on the right cushion to sit on to ensure that I do not get a pressure sore. A cushion cover for that cushion is around £120. This costs the National Health Service considerably more than it would if I sat on a piece of old, tatty foam. However, if I sit on a piece of old, tatty foam, I might be in a better position to be considered for DLA in the future. It is the same with adaptable housing, and lifts and ramps. We are getting into a very difficult situation here, where the things that should be making disabled people’s lives easier, to enable them to contribute, will actually encourage them to think about things in a very different way.

It is very important we get this right. We do not want to push disabled people back into their houses, or ghettoise them. We are in a real danger of doing that if we do not find the right balance, and make sure that disabled people have access to the right equipment to enable them to live as independent lives as possible, and to contribute towards society.

[Lord McKenzie of Luton]

My Lords, it is with a degree of trepidation that I rise to speak, having just heard those contributions. This issue presents a real conundrum. There is an argument that asks, if the social model is to identify the broader challenges to living that confront disabled people, is it unreasonable to take account of provisions and innovations of aids and appliances that society has developed to help people in their daily living? However, it is easy to state that; as the contributions we have just heard made clear, there is a question of what that will mean in practice.

We could recognise that the use of aids and appliances will not always remove the barriers that people face; we have certainly heard that explained. We should also recognise that not everyone will have access to aids and appliances, or indeed adaptations, which could enhance their quality of life. There is a conundrum that is recognised in the November 2011 Explanatory Note. If account is taken only of aids and appliances that people have and—other things being equal—that produces a low award, there is a potential disincentive to acquire those very aids and appliances that will improve people’s lives.

As I understand, what is currently proposed—as the noble Baroness, Lady Thomas, identified, this mirrors the current DLA formulation—is that the assessment will take account of aids and appliances that are normally used and can reasonably be expected to be worn or used. This seems to penalise those who have not yet acquired those aids and appliances. They will have a zero or low award, and not have the money to acquire the facilities. I wonder if it would not be a more reasonable approach, if there is to be some recognition of aids and appliances in the assessment, to take account of what people have initially, with some acknowledgement that, at a reassessment at some stage in the future, you might add those that people might be reasonably expected to use. At least that way, there is a transition.

We know that some aids can be differentiated from others on the basis that in themselves they do not overcome all the issues of mobility. Attaching higher scores for these circumstances—although we do not know what the tariff will be—does not seem unreasonable. The more I have thought about this, and the more contributions I have heard, the more difficult an issue I think it is.

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[Lord Freud]

This is the Catch-22 that a number of noble Lords have pointed out today and in the past, whereby denying oneself an obvious aid is used as a method or device to maintain a higher level of PIP. Clearly, we want to discourage that because we want people to maximise their opportunities in life. The noble Lord referred to a period in which to obtain an aid. However, that drives straight down the other path of starting to multiply the number of reassessments, which we do not want to do. There is a balance to be struck here but most people are able to get aids and appliances. They may not get the four-and-a-half kilo device of the noble Baroness, Lady Grey-Thompson. That is half the weight of my bike.

[Baroness Grey-Thompson]

My Lords, if I might interject, one of the issues is the cost of aids and equipment. You can buy a fairly okay wheelchair for £250. You can buy a semi-custom fit chair for about £3,500 and you can probably spend £6,000 on a chair. However, some aids and adaptations are very difficult to get, such as a stair lift, which costs £2,500. I tried to get one fitted in my house when I was pregnant but no company in the country would fit a stair lift in my house as the stair lift was not insured to carry two people, and as a pregnant woman I counted as two people. However, there were companies that were prepared to put one in for someone who wanted to carry their dog up the stairs. A through-the-floor lift costs £18,000. If you live in the south-east of England, moving to a bungalow is just not an option because it is so expensive. There are all these costs that keep adding up, and it is very difficult for disabled people even to think about getting the right equipment because of the huge cost.

[Lord Freud]

Clearly, one has to be absolutely sympathetic to this point. As we all know, levels of equipment can vary hugely. However, the point on this particular issue is that we will look at only readily available, cheap aids and appliances, which can be reasonably used. That will be the definition and it is the definition used today in DLA, so we are effectively porting that approach over. I think I have already asked for the amendment to be withdrawn.

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I want to understand better than I do now what the rationale is regarding the Equality Act because we know from that Act that people with cancer are deemed to be disabled at the point of diagnosis. If the whole drive here is to align with the Equality Act, then that does not quite fit. I am not suggesting that we would expect people with cancer to be able to access PIP at the point of diagnosis, but I do not see how that rationale works here. I look forward to the Minister’s response.

[Baroness Grey-Thompson]

My Lords, I support the noble Baroness, Lady Thomas of Winchester, in Amendment 86A, and I believe she has covered the amendment very clearly. I also find the qualifying period worrying. As the noble Baroness, Lady Morgan of Drefelin, has said, the first months are often the period when extra costs are at their greatest, and just as people are trying to adjust their outgoings, they are also adjusting to the impairment or illness.

I do not believe that it is the case that they will be able to receive support elsewhere. Social care support may be available, but that is means-tested and has its own application and assessment process, which we have debated quite a lot this afternoon. Support from the NHS can be very limited and not immediate and I do not think we should assume that appropriate help is that easy to find.

In Committee in another place, the Minister for Disabled People stated that this proposal was not being driven by the need to make significant savings, so why are we making this change? It has been argued that, for example, in the case of someone who has had a stroke, it may not be clear at three months what their long-term needs may be, and that may also be true at six months. However, their costs are likely to be very high during these initial stages. While no one, me included, wants to see repeated assessments, we have heard a lot about giving help to those who most need it. In the initial months following diagnosis we should look at the qualifying period as detailed in the amendment because those are the people who will need immediate help.

[Baroness Lister of Burtersett]

My Lords, I support the amendments which seek to revert to the existing qualifying period of three months. The noble Baroness, Lady Thomas of Winchester, said that six months is a long time to wait for extra resources, and we have heard from a number of noble Lords about the significant additional costs which can be incurred during this period.

However, there is a further twist in the tale—the benefit cap—which we will be discussing next week. PIP exempts people from the benefit cap but, of course, if you cannot qualify for PIP for six months then you would not only have to wait for additional resources but could find that your own resources are being significantly depleted during this period. This is very worrying. Can the Minister say whether any estimate has been made of the number of people who may be caught in this way? I suspect that it is not a large number, but one person is one person too many. It could be potentially very frightening for people to find that they might have to face this horrible benefit cap.

I hope that the Minister will accept the amendment. If not, and the six-month period goes ahead, a perhaps minimalist way of addressing the question—although it does not really address it—is that someone who qualifies after six months should have the money backdated to cover what they lost through the benefit cap.

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Moved by

[Baroness Grey-Thompson]

86DZA: Clause 81, page 58, line 32, at end insert “other than by virtue of an award made before the person reaches the relevant age”

[Baroness Grey-Thompson]

I beg to move Amendment 86DZA standing in the name of the noble Baroness, Lady Wilkins. The noble Baroness apologises, but she is unable to be present as she has an amendment to the Health and Social Care Bill in the Chamber.

This amendment is designed to ensure that disabled people receiving the new benefit—whether it is the personal independence payment or DLCA—before pensionable age are able to continue accessing support after they reach that age. I declare an interest in that I am a recipient of DLA.

This amendment would maintain the requirement that disabled people meet eligibility criteria, but would offer a significant reassurance to disabled people that their support will not diminish with age. Sir Bert Massie, as cited in Monday’s debate, has suggested that disabled people, “Join us or die”, given that the incidence of impairments and experience of health conditions increase with age, and that more than half of disabled people develop their impairment or health condition in adult life.

The older we get, the more we need support with the higher cost of living, and with the health conditions and/or impairments that life brings. DLA currently provides vital support to 845,000 disabled people over pensionable age in meeting their higher essential costs of living. This support offers a significant lifeline, and was planned for in the original legislation when DLA was introduced by the noble Lord, Lord Newton, and others, in the Social Security Contributions and Benefits Act 1992. That Act specifically refers to the age limit not applying to a DLA award made before someone attains the upper age limit. However, the Welfare Reform Bill does not make the same guarantee for the new benefit.

Clause 81 allows for regulations to be made to allow for exemptions, and the Explanatory Notes to the Bill indicate that allowing PIP to continue to be received after someone reaches pension age could be such an exemption. This would be welcomed, but leaves a gap in clarity which needs urgently to be addressed. I am aware that the Government believe that this issue should be covered by regulations. This was not the case in the original 1992 legislation, and I am unconvinced that it should be the case now.

My concern is due in part to the Public Bill Committee stage in the other place, where the Minister for Disabled People stated that the Government wanted entitlement to be addressed in regulations, to allow for flexibility. Such flexibility could include altering this entitlement in the future, and denying support to disabled people reaching pensionable age. It would offer a significant boost in confidence for many disabled people to receive reassurance during the passage of the Bill that their support will not be withdrawn at pensionable age.

Disability Alliance, and many other charities, are being approached regularly by disabled people worried about what the current plan will mean when they reach pensionable age, and whether support will end. Readers of Disability Now will also have seen this issue raised by other concerned disabled people and their families. This amendment would clarify the position and put many minds at rest.

The Dilnot Commission highlighted the pivotal role that DLA plays in preventing high-level needs escalating. This is a particularly important issue for people who are in receipt of the mobility component of DLA, as there is no equivalent to this under attendance allowance—the current disability benefit available to people who seek help after they pass pensionable age. Receiving DLA helps disabled people manage health, and prevents some avoidable NHS costs occurring. Receiving help after pensionable age could also help disabled people avoid entering council-funded residential care homes at all or prematurely. Therefore, this amendment potentially offers further financial savings in the long term, but requires the Government to work collectively and not allow a DWP silo approach to ignore the NHS and local government costs of not permitting an entitlement to be carried over to pensionable age.

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[Baroness Grey-Thompson]

My Lords, I thank the Minister for his comments, especially around what happens when those currently on PIP reach pensionable age. The noble Lord, Lord McKenzie, raised further crucial issues regarding clarity in relation to people over 65 who currently receive DLA. If the amendment is too wide, as the Minister suggested, I am sure that the noble Baroness, Lady Wilkins, would be very happy to meet with the Bill team before Report to determine the correct words to put down. As the noble Baroness is still discussing the Health and Social Care Bill in the Chamber, she will need time to consider the Minister’s comments. I am sure that she will return to this at a later stage. I beg leave to withdraw the amendment.

Amendment 86DZA withdrawn.