Health and Disability Reform

Baroness Tyler of Enfield Excerpts

Wednesday 1st May 2024 Lords Chamber

[Baroness Sherlock (Lab)]

My Lords, I am grateful to have the opportunity at last to ask some questions about this Statement, because the route here has not been pretty or swift. The Prime Minister made a speech on 19 April about the need to reform sickness and disability benefits. Cue lots of headlines about sick note culture and the need for a crackdown. Then, there was silence: 10 days of expecting a Statement which did not come; 10 days of asking for detail; 10 days during which, if noble Lords are anything like me, they will have had a succession of messages from sick and disabled people who were very anxious about what was going to happen to their benefits.

When the Secretary of State finally talked, it was not to Parliament but to the media, of course, so we began to find details there. The Telegraph ran the headline, “Disability benefits could be vouchers, not cash”. The Sunday Times said, “Depressed and anxious face losing … benefits”, with the sub-headline, “Tories plan welfare reform as election divide”. I sorry to say it, but there we have it. The Secretary of State was quoted in the Sunday Times as saying that

“it was ‘extraordinary’ that Labour was refusing to say whether it supported his benefit changes”.

At this point, there was no document, there had been no Statement in Parliament, and no details were available. In fact, when the Statement was made in Parliament, the Secretary of State did not even observe the usual courtesies of giving an advance copy to the Speaker and the shadow Secretary of State. I do not know why the Government would sit on the Statement and document for 10 days and then publish them in the week of the crucial local elections—it is a mystery.

Now we have the details, although it is not very detailed. I read the Green Paper from cover to cover, and if you exclude questions and the padding in the annexes, there are 14 pages of content. The Green Paper could hardly be any lighter green.

How did we get here? In 2013, the Government abolished disability living allowance and created PIP. According to the Green Paper:

“PIP was intended to differ from DLA by being fairer (by paying greater regard to needs arising from mental health, sensory and cognitive conditions)”.


It was also to be

“more consistent … objective … transparent … sustainable … modern and dynamic”.

The Government committed to undertake an independent review of PIP after two years and again two years later. There have been two consultations covering PIP since then.

Then, in July 2021, the Government published Shaping future support: the health and disability green paper, which launched a consultation on PIP and ESA. Nearly two years later, in March 2023, the Government published a health and disability White Paper which set out the Government’s vision

“to help more disabled people and people with health conditions to start, stay and succeed in work”.

That paper announced the plan to remove the existing universal credit limited capability for work and work-related activity element and replace it with a new universal credit health element. It was also going to abolish the work capability assessment, which was people’s gateway to those benefits, so there would be only one health and disability functional test in future: the PIP assessment.

Now, a year after that White Paper, we are back to a Green Paper, which proposes abolishing the PIP assessment. What is going on? How will anyone be assessed for anything? Will the Minister tell us what happens to people who are clearly too sick to work at the moment but are not disabled? How will they have their support assessed when there is neither a work capability assessment nor a PIP assessment? Is the plan still to have a new universal credit health element, or is that under consideration again as well? The Government suggest that some health conditions can be taken out of PIP assessments. Can the Minister tell us which conditions they have in mind? PIP is also passport to the carer’s allowance. How will that work if there is no PIP assessment? Do people risk losing their benefits and their personal care from family or friends at the same time?

The Government said that DLA was the problem and PIP was the answer; now it seems that PIP is the problem. The fact is that we have a problem in this country: we have a record 2.8 million people locked out of work due to long-term sickness. But what or who is to blame? How much of that is down to the Government's record on the NHS? When the Statement was debated in the Commons, the chair of the Work and Pensions Select Committee pointed out that:

“PIP assessment providers confirm that worsening delays in NHS treatment are a big factor in the increase in the number of people applying for PIP”.—[Official Report, Commons, 29/4/24; col. 52.]


We have also been hearing strong hints that the real problem is people with mental health problems. I do not doubt the Minister on this, but politicians in general need to be very careful about how we speak about mental health, for risk of stigmatising people or making them afraid to speak out or seek help. Can the Minister say whether the Government’s plans involve treating people’s mental and physical health differently? If so, can he explain the legal basis for making such a distinction? Can he also say what the Government will do about the near impossibility, for many people, of getting any timely mental health support at the moment?

A Labour Government would take a different approach. Among those who need the help of the state, there are some people who are temporarily or, in some cases, permanently unable to work and who need support to have a decent life. There are many others who need extra help to get, keep and advance in a job, and it is the state’s job to give that to them. For those people, health and work are two sides of the same coin.

Rather than blaming people for being sick, a Labour Government will support our NHS. The last Labour Government delivered the highest patient satisfaction level on record, and that is the record on which we want to build. We will drive down NHS waiting lists by getting patients treated on time, with 2 million more weekend and evening appointments, and we will ensure more support for those with mental health problems through an extra 8,500 mental health staff.

We will focus constructively on work, the other side of that coin, because the costs of failure in this area are a disaster for individuals and the country. Where it is possible, work is good for us—for our mental and physical health. Labour will have a new deal for working people, improving rights for the first time in a generation. We will drive up employment in every region, devolve employment support and end the tick-box culture in jobcentres. We will tear down the barriers to work for disabled people and provide help for young people.

Labour will carefully review the issues raised by this latest Green Paper. Clearly, sick and disabled people need appropriate help and support, but we also want to be a country where disabled people have the same right to a good job and the help to get it as anyone else. We will judge any measure that the Government bring forward on its merits and against that principle. I look forward hearing more from the Minister.

[Baroness Tyler of Enfield (LD)]

My Lords, I will not repeat what the noble Baroness, Lady Sherlock, has just said about the lead-up to the publication of this Green Paper, but it can hardly be described as ideal. When announcing the Green Paper and the reforms to PIP on Monday, the Prime Minister said that something had gone wrong since the pandemic, leading to more people not working because of long-term ill health; he singled out the rise in people unable to work because of mental health conditions. Of course, I agree with helping people to get back into work, where that is possible, and I agree that for some people with mental health problems, it can improve their well-being. What I worry about greatly is putting the spotlight on people with mental health problems in such an unhelpfully divisive and—I agree—stigmatising way.

We need to go back to the root causes here. Can it be any surprise that so many people are claiming sickness and disability benefits when millions are still waiting for NHS treatment, and mental health wait times are through the roof, due to an acute shortage of mental health professionals, including doctors, nurses and counsellors? Does the Minister agree that if the Government are serious about getting people back to work, they need first to reduce waiting times for NHS treatment and tackle the crisis in our mental health services which makes accessing mental health treatment so difficult and protracted?

The Prime Minister also claimed that these changes are about “compassion”, but does this not rather miss the point that most young people claiming PIP are doing so because they have ADHD or autism, rather than anxiety and depression? Last year, 190,000 young people claimed PIP due to autism, ADHD or other learning disabilities, compared to just 129,000 claiming for all other disabilities. Could the Minister explain why, in the announcement of these proposals, there has been such a strong focus on anxiety and depression and how far this is based on the evidence?

I am concerned that potentially stopping cash payments will be seen as an affront to the dignity of benefit recipients. The BBC News website yesterday quoted one 71 year-old recipient, who said that for her PIP is about

“maintaining independence, not being a burden on my family and keeping my dignity”.

It could hardly be said that the reaction from the sector has been favourable. The charity Scope has said that these plans do not fix the underlying issues faced by disabled people. The chief executive of the charity SANE has pointed out that

“mental health problems are often invisible and fluctuate from month to month or day to day, and … assessments for benefits are all too often based on ‘snapshot’ judgments that do not take account of how hidden and disabling mental illness can be”.

Can the Minister say what consultation took place with the mental health sector and those who work closely with people directly affected by these issues prior to the Green Paper being published?

Finally, I turn to a wider issue. The Statement talks about a

“new conversation about how the benefits system can best support people to live full and independent lives”.

I am sure we can all agree with that, but we need to look at these issues in the round. Being able to live independently in the community can often rely on the help and support of unpaid family carers. Does the Minister agree that it is simply unacceptable for over 150,000 unpaid carers to be facing severe financial penalties—pushing many into debt or financial hardship —for often quite unknowingly breaching the earnings limit while caring for a loved one? What urgent steps are the Government taking to stop this outrage, and will they agree to an amnesty while it is being sorted out? If the Minister cannot answer that now—I accept it is not within the immediate focus of this Statement—would he please write to me?

[The Parliamentary Under-Secretary of State, Department for Work and Pensions (Viscount Younger of Leckie) (Con)]

My Lords, I start by thanking the noble Baronesses, Lady Sherlock and Lady Tyler, for their questions; I will do my best to answer them.

Indeed, the Prime Minister did make a speech on 19 April, and I was there in person. He covered a whole range of announcements in the world of welfare. I found it to be a very caring and compassionate speech; that is a really important point to make, because it did not come across in some quarters in the media. On how the Statement was communicated, I will not dwell on that other than to say that both noble Baronesses will know that apologies were given. That is on the record, and I do not think it is right that I should say anything more about that now.

The noble Baroness, Lady Sherlock—and it was alluded to by the noble Baroness, Lady Tyler—spoke strongly about mental health and the link with physical health. I want to make a few remarks about this, because we should see it as a sign of progress that people can talk about mental health more openly. The Government will never dismiss or downplay the conditions that people have; it is precisely because we take mental health so seriously that we need to reform the system. There is no one-size-fits-all approach, but the current system does not reflect that. It is simply wrong to write people off when there is a growing body of evidence that good work can improve mental health.

In terms of the evidence raised by the noble Baroness, Lady Tyler, I visited a jobcentre only this morning and asked various questions of the job coaches. I reassure her, or alert her to the fact, that the evidence is certainly there. I am sure she will know from her own experience there is an increased level of mental ill-health, some of a severe nature. Action must be taken.

But it is more than that; it has been over 10 years since the introduction of PIP. We need to ensure that our system is fair and accurately targeted at those who need our support most. Although we have made significant progress, the disability benefits system for adults of working age is not consistently providing support in the way it was intended. In terms of a point raised by the noble Baroness, Lady Sherlock, I reassure her and the House that we will and intend to continue to support those who need it. That includes those who genuinely are not able to work—that is what we are doing at the moment. In terms of what may come out of the Green Paper, and indeed this conversation or consultation, that is a most important point that I want to emphasise—which, by the way, the Prime Minister also emphasised.

The noble Baroness, Lady Tyler, asked about the importance of investing in mental health services. She is right; we want to ensure we are providing the right support to those who need it most, targeting our resources most effectively, and supporting disabled people and people with long-term health conditions to live independently and reach their full potential, irrespective of whether this is a physical or mental health condition—which alludes to the point that the noble Baroness, Lady Sherlock, made. Mental health remains a key government priority; that is why we are investing £2.3 billion a year into NHS mental health services, and why we brought in the long-term workforce plan, which will deliver the fastest expansion of mental health services in the NHS’s history. Just this morning, as I said, I visited a jobcentre and found out more about that.

The noble Baroness, Lady Sherlock, asked about PIP and mental health. I will give a few more statistics to back up the views I have given so far. In 2019, there were an average of 2,200 new PIP awards a month in England and Wales, where the main disabling condition was mixed anxiety and depressive disorders. That figure more than doubled to 5,300 a month in 2023. As I said earlier, we will and must continue to support everyone with mental health conditions, recognising that the severity and individual circumstances will vary and that there is no one-size-fits-all approach. Those with the most debilitating conditions should be entitled to the support they need, as I said earlier. That is exactly what PIP is intended to do, and that core aim will not change.

However, we need to have an honest conversation, which we have just started, about whether individuals with some conditions are better served by treatment and tailored support than by cash payments—which I think was a point raised by one of the noble Baronesses. To increase support, we have expanded mental health provision. Altogether, between 2018-19 and 2023-24, spending on mental health services has increased by £4.7 billion in cash terms, increasing access to mental health services. This has put 400,000 extra people through the NHS talking therapies programme, which the House will be aware of.

On the question raised by the noble Baroness about the amount going on, I say that there is a huge amount. We fully intend to go ahead with the reforms that we announced in Transforming Support: The Health and Disability White Paper, because the Government are committed to doing everything that we can to help disabled people and people with long-term health conditions. These changes are separate from this PIP consultation but, as we develop our proposals, we will consider how some interactions with the current welfare system will be reflected in a reformed system. This will be carefully worked through and reported on before we consider introducing any changes. I say again that this is the start of a conversation. We are asking as many people as possible to input into the Green Paper. Already, we have received a good number of responses in the past few days since it was announced.

The noble Baroness, Lady Tyler—it might have been the noble Baroness, Lady Sherlock, as well—spoke about too many piecemeal publications and not enough action. Since 2010, we have delivered significant welfare reforms, including introducing universal credit, a modern benefit that ensures that people are better off in work than on benefit. There are nearly 4 million more people in work than in 2010 and 1.1 million fewer people in absolute low income. However, we are now seeing a new challenge—they come up in government sometimes —that emerged in recent years and accelerated post pandemic. As the Prime Minister said, the current system is unsustainable, unfair for taxpayers and no longer targeted at those who need it most. That is why it is essential that we take action.

On the point raised by the noble Baroness, Lady Tyler, about carers, there probably is not enough time to go into everything I want to say, but perhaps I can give her some reassurance on the issues circling at the moment. We must carefully balance our duty to the taxpayer to recover overpayments with safeguards to manage repayments fairly. Claimants have a responsibility to ensure that they are entitled to benefits and to inform my department, the DWP, of any changes in their circumstances that could impact their award. To be helpful, we have improved, rather urgently, customer communications to remind them of the importance of telling us about any earnings, including in the annual uprating letter that all claimants receive. We are looking to make the best possible use of earnings information collected by HMRC—so-called real-time information—to help to prevent some overpayments occurring in the first place. I reassure the noble Baroness that we are taking this extremely seriously.