Welfare Reform Bill

Baroness Thomas of Winchester Excerpts

Wednesday 16th November 2011 Grand Committee

[Lord Low of Dalston]

I particularly support the idea of a trial period before incurring huge public expenditure in reassessing 2 million disabled people, many of whom really do not need it, for example, if their circumstances are unlikely to change. Where there is written evidence of severe impairments, it is simply common sense to accept that evidence and avoid putting people through costly and potentially distressing face-to-face interviews. Setting out criteria that would signal eligibility for PIP without an interview is an administratively simple way to indentify those who have severe impairments that have already been assessed through written evidence as giving rise to a higher level care or mobility need.

The Government have said that they do not think it is right that we should judge people purely on the type of health condition or impairment they have, making blanket decisions about benefit entitlement. One can understand their desire to personalise the assessment process when the impact of an impairment may not be clear. However, it is obvious that in some cases the impact is clear from written evidence and beyond dispute in terms of its implications for the rate of PIP that should be awarded. For some groups of people it is perfectly clear from the severity of their impairment that they should be eligible for enhanced rates of PIP without further assessment. For example, if someone is deafblind, a face-to-face interview to establish that they have mobility needs of the highest level is barmy. If someone has no sight at all or no legs, no further assessment is needed to confirm that they have a high level of mobility need. In cases such as these, a face-to-face interview is simply a waste of money. In addition to avoiding unnecessary stress for severely disabled people, this amendment would save money for the taxpayer. It feels pretty much like a no-brainer to me.

[Baroness Thomas of Winchester]

My Lords, I strongly support this amendment and perhaps I might read it out, because it is a long time since we first started talking about it. It would insert:

“including a requirement for the decision maker to collect evidence from the claimant’s own health care professionals as a part of the decision making process”.

There is a strong suspicion that this is not always done. The only thing that I would quibble with in that amendment is that not only does the decision-maker have to collect evidence, it has to be taken into account when the decision-making process is gone into.

My question for my noble friend is about a sentence that I found in one of the documents we were given—I cannot now remember which one it is. It says:

“Decision Makers will change erroneous decisions rather than send them to a Tribunal”.

The next sentence says:

“If a claimant’s points at issue are not resolved, they can still appeal to the HM Courts & Tribunals Service”.

I had to go to a tribunal having had my papers re-examined, presumably by a decision- maker. What will change about the process now with PIP? I am not quite sure, reading between the lines, what the two sentences that I have read out mean. Are things going to change from now, or not?

[Lord Touhig]

My Lords, I have already spoken in this debate but I ask the Committee’s indulgence to make one other brief comment. The noble Baroness, Lady Gardner of Parkes, has tabled Amendment 86ZAA in this group. Yesterday, she was mortified when she realised that she has a commitment today which it is impossible to break and she cannot be here. I know that she has apologised to the Minister. She has asked me to extend that apology to the whole Committee and asked that I make one brief comment on her behalf. If she had been here, she would have said that if a person has a clearly diagnosed and irreversible condition, they should not be required to have continuing assessments as it causes them concern and adds unnecessary cost to the system. I think that point has been made by other noble Lords in the debate, but the noble Baroness was really keen to get that point on the record and, again, she apologises for not being here today.

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[Lord Low of Dalston]

Before the Minister concludes, I am sorry if I was not paying attention, but I did not hear him respond to the points made about our amendment about cases where the written evidence was clear and unambiguous, where there were very high levels of need which, the nature of the impairment made clear, were unlikely to change. I heard the Minister say that the assessment process would be implemented with flexibility, but my impression was that the avoidance of a reassessment would be a pretty exceptional situation. Those of us who support Amendment 86ZB believe that cases where people's circumstances are unlikely to change and their high levels of need have been unambiguously and unequivocally evidenced are not isolated exceptions. That is a widespread and general circumstance. Can the Minister respond a bit more positively on that?

[Baroness Thomas of Winchester]

Will the Minister also respond to my question, when I asked whether the sentence:

“Decision Makers will change erroneous decisions rather than send them to a Tribunal”

is a change from the present system?

[Lord Freud]

My Lords, taking those questions in the order that I fancy, let me start with the noble Lord, Lord Low. If I did not make it unequivocally clear, let me do so: where the written evidence is unequivocal, we will take decisions on the written evidence and continue to do so. I hope that that is absolutely clear, and I am sorry that I did not say that with enough emphasis.

On the point made by the noble Lord, Lord Wigley, the National Autistic Society is undertaking some extremely good initiatives. I was just considering one in Northern Ireland with Jobcentre Plus. To be honest, I was not aware of that particular one mentioned by the noble Lord, but that is exactly the kind of initiative that we will want to incorporate as we build the programme. We understand that the issue of autism is important.

My noble friend Lady Thomas refers to how the WCA works, rather than how the PIP might work, because we have not completely developed it. The best I can do on that issue is to write to her setting out the position precisely. I hope that that is satisfactory for her.

[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.

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Moved by

[Baroness Thomas of Winchester]

86ZZZW: Clause 78, page 57, line 2, at end insert—
“(d) must disregard aids and adaptations used by a person in assessing their mobility”

[Baroness Thomas of Winchester]

My Lords, as we all know, at last we have the second draft of the PIP criteria, with the responses to the consultation analysed and with the Government's response. We now have to call aids and adaptations “aids and appliances”, although aids and adaptations was the phrase in the consultation. I declare an interest in that I use a huge number of aids and adaptations, as I expect my fellow Peers along this Bench do too. The confusion about the name reflects a bit of confusion about the whole issue in the DWP. I must say that I am not much the wiser having read both “The approach to aids and appliances” on page 32 of the explanatory note and “How aids and appliances should be considered”, on page 17, but I start on page 6. Under the heading, “Refining the draft criteria to produce a second draft”, the sixth bullet point states:

“To ensure that the assessment does not unfairly penalise individuals who choose to use aids and appliances to improve their independence, the assessment now also considers cheap, widely available aids and appliances which can ‘reasonably be expected’ to be used, in a similar way to Disability Living Allowance. We also recognise that aids and appliances do not necessarily remove barriers and may attract costs; therefore descriptors which refer to these normally attract a scoring descriptor”.

The last thing we need is for those who make the most of every aid and appliance they can find to be unfairly penalised; or for those who do not even try to find suitable aids and appliances which might help them to be rewarded. Aids and appliances should be complementary to benefit entitlements, not in competition with them.

Many respondents to the consultation, we are told, argued that the use of an aid or an appliance does not necessarily remove a barrier to participation, and they are quite right. We cannot be certain that the Government believe that. They state at paragraph 4.25:

“Some respondents felt that we should not take the use of aids and appliances into account in the assessment. We do not feel that this approach is appropriate as we want entitlement to Personal Independence Payment to be based on an individual’s level of participation in society. As such, if individuals are participating well with the help of aids or appliances, we believe that this should be reflected”.

What does this mean? There is no useful “for instance”. However the next paragraph goes on to say that it is recognised that,

“barriers and costs may not be removed by the use of support aids and so descriptors describing the use of an aid or appliance to carry out activities will usually attract a score in the assessment”.

These two sentences must be read together so that the first is at all times qualified by the second, although we do not know what score might be given in the assessment.

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[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.

[Baroness Thomas of Winchester]

My Lords, I think that proves my point about the confusion over this issue. This has been an extremely illuminating debate. I am very grateful to my fellow Peers along this Bench. We have heard about special shoes, small chair-lifts for small chairs, stair lifts, carpets, lifts in the House of Lords, cushions and so on. I fear that the confusion in my mind over how aids and appliances will be taken into consideration has not been entirely removed. I shall read what the Minister said with care. If I were younger, I would go to my assessment having borrowed the electric wheelchair of the noble Baroness, Lady Wilkins. That would be the answer. I could cross my fingers behind my back and say that it was mine, and I would then get all the points that I needed. There are some real problems.

However, I end on a note that the Minister might enjoy. The prize for the best disabled lavatory that I have ever come across goes to one in the Department for Work and Pensions in Caxton House. It should be open to the public for general inspection. I hope my noble friend will pay it an official visit at his convenience. It has an electric control that you press, which means that it goes up and down without any effort on the part of the user. As an example of a brilliant adaptation, it takes the top prize. For the moment, I beg leave to withdraw the amendment.

Amendment 86ZZZW withdrawn.

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[Baroness Thomas of Winchester]

My Lords, I support the amendment that was powerfully moved by the noble Baroness, Lady Howe. I shall also speak to my Amendment 86A, which enables an eligible person to receive PIP after three months rather than six. The balancing corollary of that amendment is my next amendment, Amendment 86B, which changes the length of time that a person's condition is estimated to last from six to nine months, so the envelope of time in these amendments is not being stretched beyond a year. It is just being differently configured, which fulfils the Government’s desire to align PIP with the definition of long-term disability in the Equality Act.

I gather that another simplification which the Government want is to align the waiting time for PIP with attendance allowance. They have cited the approval of several organisations for this change, but is my noble friend really telling us that these organisations would rather people waited for six months for PIP just for the sake of this alignment? This is certainly not my experience.

The reason my amendment seeks to keep the qualifying period to three months is very simple: some conditions of a long-term nature may have a sudden onset; some may not have such a sudden onset but might be able to be diagnosed only several weeks after the onset of symptoms. People with rheumatoid arthritis, for example, which affects about 400,000 people in the UK, are often only given an official diagnosis after six weeks of certain specified symptoms. I mention that disease specifically because arthritis in general forms 18 per cent of the DLA case load; it is at the very top of the list.

Next on the list are mental health conditions at 17 per cent. For anyone suffering from a severe mental health condition, applying for DLA would not be the first thing they think of, and waiting for six months, when PIP comes in, to help with care is a very long time.

There are then those diseases which may have a devastating impact on people immediately, such as a severe stroke or heart attack, a serious accident, amputation or an unexpected diagnosis of cancer which demands challenging treatment straightaway. We may hear a little more about that from the noble Baroness, Lady Morgan. People with any of these conditions may need the extra help which PIP could give comparatively quickly to stop them from falling into debt as they manage their condition with all its ramifications.

This is even more important in these days when local authorities are so overstretched financially that they are becoming reluctant to carry out more than minimal adaptations to people’s homes, let alone provide adequate help with caring. Those affected may need to buy for themselves various mobility aids, safety devices and other equipment, or perhaps set up a home alarm system. Their homes may need extra heating; they may have increased laundry requirements; they may need special diets; and they may have to rely on expensive taxis to get to hospital appointments and for other purposes. If the social model of disability means anything at all, then a disabled person is likely to have to rely on taxis if they want to go out and about, particularly during the winter.

Turning to those conditions which are not sudden onset such as my own—adult onset muscular dystrophy—it would be foolish for someone to try to get PIP too early while they are still able to manage their impairments relatively easily because they will almost certainly fail the assessment. On the other hand, if they know that they will have to wait, whatever happens, for six months before receiving any extra resources, they may decide they should at least start the process, particularly if they are beginning to fall into debt with managing their condition.

So when should they start the claim? I understand from what the Minister for Disabled People said in the Public Bill Committee in the Commons that the qualifying period for PIP starts at the point where someone is first entitled to it regardless of whether a claim has been received, and that even a lengthy spell in hospital can be part of the waiting period. That may be a helpful message for someone who has had a stroke or a bad fall, but it is not always possible to know exactly when a person might qualify.

At present, the waiting time for DLA is three months. By changing it to six months, the Government have said that this is not about saving money but about the right benefit going to the right people, or words to that effect. Presumably, by doubling the waiting time, they believe that three months is too short a time to be able to assess someone’s condition. They are possibly thinking that someone who has suffered, for example, quite a severe stroke might apply straightaway for PIP but, after six months, might be much better and able to manage the impairments they still have. However, looking at the case load for DLA, only 3 per cent of claimants have stroke-related conditions. This is presumably because the majority of stroke patients are past retirement age and thus past qualifying for the first time for DLA.

If PIP is to be an in-work as well as an out-of-work benefit, which it is, surely it is better to allow a person to claim the benefit after three months, not six, as it is likely to help them get back to work and to participate once again in society more quickly, for example by travelling to work by taxi or by taking a cab to the station.

The table of conditions that people who claim DLA are diagnosed with is very illuminating. People with both osteo- and rheumatoid arthritis, which as I said come top of the list, are very unlikely to get better after three months. Those with stroke-related conditions and malignant diseases are each just 3 per cent of the total. It is not as though a large number of DLA claimants with these conditions are trying to claim after their condition has improved. In fact, the table shows that the Government’s argument about a person’s condition not being stable after three months does not really stack up. I read from the table that most people almost certainly do not apply for DLA at present until they really feel they have to.

To sum up, six months is a long time to wait for extra resources if a person has had a diagnosis of a long-term severe condition. The Minister in another place talked about a person’s condition settling down. However, for many of us our conditions never settle down—they go on progressing. If the Government are implacably opposed to retaining the three-month waiting time for PIP, maybe they would agree to, say, an assessment on the papers after a year so that a person’s entitlement can be looked at properly again. I think this will come up later on.

If the Government insist on the six-month waiting time for all applicants, I fear it will be understood to be about saving money in the short term in the hope that people will be put off from applying. I am encouraged to hear that my noble friend and his fellow Ministers are still listening and I hope this means they are hearing all the arguments for changing the qualifying period back from six months to three.

[Baroness Morgan of Drefelin]

My Lords, this is a very important debate. I support the idea of keeping the qualifying period for PIP at three months. I also hope this debate will look at the idea of the prospective period moving from six to nine months if the Minister sees that as an appropriate practical way of dealing with the Government’s intention to align the qualification period for PIP with the Equality Act, as I understand it.

I, like many, am extremely concerned that the proposals here will have a devastating impact on disabled people, especially those with sudden-onset conditions such as cancer. Cancer patients often see sudden changes in their household income combined with significant cost escalation on diagnosis. This can make cancer patients particularly vulnerable to financial difficulties and in need of immediate financial support.

Why do people with sudden-onset conditions need support immediately? We know that cancer treatment and its debilitating effects can often begin very quickly after diagnosis, as the noble Baroness, Lady Thomas, has already explained. The associated support needs arising from that treatment are often immediate and, importantly, the first six months can be the period when extra costs are at their greatest as people try to adjust their outgoings to their reduced income. Research by Macmillan found that 80 per cent of cancer patients who experienced increased costs reported that they were greatest in the first six months.