Welfare Reform Bill

Baroness Hollins Excerpts

Tuesday 17th January 2012 Lords Chamber

[Baroness Wilkins]

My Lords, I support the amendment, which seeks to ensure that the assessment for the new entitlement is fit for purpose and fulfils the Government’s commitment to the social model of disability. As has already been noted, DLA occupies a unique space in the welfare benefits system as it recognises that disabled people face a plethora of extra, often prohibitive, costs as a result of living in our society with a condition or impairment.

We should all warmly welcome the Government’s repeated commitment to the social model of disability, for which, as many of your Lordships know, disabled people have fought long and hard. At the heart of the social model is the recognition that it is our society, not just their bodies, that disables people with health conditions and impairments. However, I fear that the proposed assessment for the new entitlement does not reflect this commitment. Despite the Government’s assurances in Grand Committee, the Minister admitted that the proposed test,

“is not a full social model assessment; it is not intended to be”.—[Official Report, 14/11/11; col. GC 199.]

I ask the Minister in his response to clarify to the House and disabled people why such a commitment was ever made in the first place.

The second draft of the PIP assessment criteria includes some small improvements from the first. However, it does not go nearly far enough. By assuming that a medical assessment will capture social and environmental barriers to independence, the Government risk homogenising the diverse difficulties that disabled people face in their everyday lives. The new threshold document makes many mentions of extra costs and barriers, but only a few of these will be captured by an assessment that looks exclusively at impairment.

It is with this in mind that I support the amendment of the noble Baroness, Lady Grey-Thompson. The assessment for the new entitlement must consider the real social, practical and environmental barriers faced by disabled people with impairments living in our society. I, along with disability charities such as Scope, disabled people’s organisations and disabled people across the country, voice great concern that the Government are reneging on their commitment to the social model of disability. Doing so would undo decades of campaigning for and progress towards a better and more equal society.

[Baroness Hollins]

My Lords, I thank the noble Baroness, Lady Browning, for her honest and enlightening contribution. I speak as a doctor and as a mother; I have two adult children who are in receipt of disability living allowance.

I wish to talk about the medical approach to disability. As a doctor, I have often been accused of being very “medical model”, usually by disabled people. The medical model to disability is reductionist. Many doctors and other health professionals do not understand the social model; they do not understand the social, practical and environmental barriers that people with physical and mental impairments face. I support the amendment, but it would require skilled and sensitive assessments to be available and they would need to be delivered by people who understand the social model.

--- Later in debate ---

[Baroness Hollins]

My Lords, I shall speak briefly in support of this amendment and Amendment 50B. I spoke at length in Committee in support of the requirement for the decision-maker to collect evidence from the claimant’s own health professional, and I do not intend to repeat myself. However, I should like to make a specific point about the requirement in Amendment 50B that,

“persons approved by the Secretary of State to undertake assessments have specific training in all mental, intellectual and cognitive disorders”.

This is because it is necessary to state that specialist skills are required in assessing someone with autism, learning disability or mental illness, and I know that it is intended that such expertise should be provided. However, most medical doctors do not have these skills. Indeed, Professor Steve Field, when writing about the NHS Future Forum in connection with the Health and Social Care Bill, pointed out in his most recent papers that it is of some sadness and regret that most doctors do not have training in these specialties, particularly those relating to learning disability and autism.

The other point I should make is that in psychiatry these are also specialist skills and not all psychiatrists have them. All will be good at assessing mental illness, but not all will have expertise in assessing people with learning disability or autism. That requires additional or different specialist training. I wish just to draw that to the Minister’s attention.

[Baroness Hayter of Kentish Town]

My Lords, these amendments would improve the assessment process for the new PIP and allay the fears of many people with disabilities that the poor experience of the ESA assessments, where around 40 per cent have been successfully appealed, is not replicated under the new benefits system.

Amendment 50B relates to the training of those undertaking face-to-face assessments to ensure that they have knowledge of mental, intellectual and cognitive disorders, clear guidance about when to access more specialist advice, and a guarantee that such advice will be available. In Committee, we received some encouragement from the Minister who stated:

“Assessors will be required to have a broad training in disability analysis as well as training on specific impairments … we intend to ensure that they have sufficient training in mental, intellectual and cognitive impairments … and will stipulate this in our contracts”.—[Official Report, 16/11/11; col. GC 263.]

Perhaps the Minister could let us know what budget has been set aside for such training.

Amendments 50C and 50D would exempt certain people from a face-to-face assessment where sufficient evidence is available via other means. This would actually save money for the Government. I hope that the Treasury is listening. Implementing face-to-face assessments was to have cost about £675 million. The amendments would reduce the costs by removing from the process claimants for whom a face-to-face assessment is clearly unnecessary. This would help those with lifelong or degenerative conditions, for whom a face-to-face assessment could be stressful. For example, about half those with MS or Parkinson’s are receiving the highest level of DLA. Putting them through an expensive and stressful face-to-face test seems unnecessary.

Again, we received some assurance in Committee. The Minister stated that,

“where there is already sufficient evidence on which to make a decision … we completely agree … a face-to-face consultation should not be required”.

I hope that the flexibility would be there for that. However, he also argued that other than for those with a terminal illness,

“we do not agree that there should be different rules or processes for different groups of people … on the basis of impairment type”.—[Official Report, 16/11/11; col. GC 261.]

Yet, if the Minister is prepared to accept that those with a terminal illness should not be subject to unnecessary assessment, surely the same argument could be applied to those with degenerative conditions where there is no hope of improvement. We look forward to any assurances the Minister can give that unnecessary face-to-face assessments will not be necessary.

If he is not persuaded by me, perhaps he will be persuaded by someone of his own political background—the Mayor of London, Boris Johnson. I have never quoted from one of his speeches before. He writes:

“Evidence from the individuals GP and/or a consultant will provide an accurate assessment of need. It would be difficult for a healthcare professional in a one-off meeting to elicit a comprehensive response about the daily reality for each claimant. Face-to-face meetings … could prove … inappropriate for an individual who may have difficulty with social contacts, such as those with autism, or for those with an intellectual or mental health disability”.

This brings me to the first amendment in this group which would ensure that the assessment process always takes account of evidence from the claimant’s old healthcare professional. It builds on the experience of the work capability assessment for ESA and is to help the Government to avoid history repeating itself. Unfortunately, in this case, it would be as tragedy not farce. The problem with the current proposals is that they put the onus on the claimant to collect the medical evidence and also to have the knowledge that would be helpful to provide this. As we have seen with ESA assessments, it is exactly this that often leads to unnecessary duplication as a case is assessed and then reassessed in the light of the evidence from the GP or professional. The initial failure to consider such evidence has contributed to the very high and expensive success rates.

In Committee the Minister argued that while medical evidence could be of use, he felt that it was not necessary to gather evidence in every case. He said:

“In some cases what the claimant has already told us … will be sufficient. In other cases, information … might be likely to add only limited value”.—[Official Report, 16/11/11; col. GC 261.]

Surely it would be better to err on the side of caution, given the widespread inaccuracy of the ESA assessments and the need to ensure that the personal independence payments do not follow the same route. Medical evidence is bound to assist the decision-maker in far more cases than those in which it proves unnecessary.

This is a modest amendment. It seeks to ensure that the introduction of personal independence payments proceeds smoothly and more importantly to ensure that the right benefit is paid to the right people. I hope the Minister will accept this. Certainly it would have our full support.