Inflammatory Bowel Disease

Lord Grayling Excerpts

Tuesday 31st January 2012 Westminster Hall

[The Minister of State, Department for Work and Pensions (Chris Grayling)]

It is a pleasure to serve under your chairmanship, Mr Leigh. I congratulate the hon. Member for Islwyn (Chris Evans) on securing the debate. What we have heard in the past 15 minutes is an example of this House at its best, where we all seek in as positive a way as possible to have an influence on the lives of people who are struggling with very challenging circumstances. There is no doubt that that applies to those who suffer from the two main conditions we are discussing in this debate, Crohn’s disease and ulcerative colitis, both known as inflammatory bowel disease. We understand that they are serious conditions. In severe cases they require hospital treatment and surgery, as we have heard from my hon. Friend the Member for Brigg and Goole (Andrew Percy), and they make life extremely difficult for those who suffer from them.

I would like to deal with the hon. Gentleman’s questions in two parts. In the latter part of his remarks he referred to how we treat people with the conditions in the benefit system. I would like to touch on that first, and then on employment and universal credit, which I believe will help people with fluctuating conditions.

I start with the question of ensuring that we provide appropriate support through the benefit system for those unable to work because of the scale of their condition. We seek through the work capability assessment to take sensible decisions about those with fluctuating conditions. I hope and believe that the work we have put in place over the past 18 months will improve the way the WCA works and responds to fluctuating conditions. We are continuing to look at how to improve the process in relation to fluctuating conditions.

Where the effects of the condition are such that an individual is unable to work, they will and should receive appropriate support by way of employment and support allowance. Individuals with IBD are most likely to score under the incontinence descriptor of the WCA, which recognises that in the workplace an important consideration is personal dignity. It looks at continence in relation to the ability to maintain continence of bladder or bowel or prevent leakage from a collecting device. Additionally, individuals who are either moderately or severely affected by the disease may also have restrictions in a number of other work capability assessment areas, for example, where there is low body weight, malnutrition, persistent pain and fatigue.

As a result of the hon. Gentleman initiating the debate and a number of other people raising concerns with my office recently about these particular fluctuating conditions, we have looked again at how we are handling people with the conditions who are going through the work capability assessment, because I want to ensure that we get it right. In fact, all we have identified is that people with a primary diagnosis of the two different IBDs we are talking about are more likely than other groups to be allowed employment and support allowance, to reflect the high level of debilitation experienced by many individuals with such conditions.

The majority of people with IBD who have completed their work capability assessment are allowed employment and support allowance. The statistics show that they are more likely by around a third to be placed in the support group or the work-related activity group than the employment and support allowance client group as a whole. I think we see a picture of a system that is reflective of the nature of the challenges that these people face. We will not always get it right; I never pretend that that will be the case. From what I can establish, we are already reflecting, in the way we handle people with IBD, a recognition of the severe and significant issues it can pose for sufferers.

The work capability assessment considers each case on its merits. Alongside that, it is important to state that, as the hon. Gentleman rightly said, many people can and should continue to work. There is a duty to ensure that employers understand, help, and work with people to make sure that they stay in the workplace, and I praise him for his comments on that. We have therefore ensured that the work capability assessment recognises that some people can manage their conditions successfully and return to work. In some cases, symptoms might be less severe, or might fluctuate so that they are unable to work for only short periods. Others might respond well to medication and be unlikely to have any long-term functional restrictions. For those people, it is important that we provide them either with appropriate support to stay in the workplace or with help to get back to work.

We can all play a role, as the hon. Gentleman is doing today. I also pay tribute to my hon. Friend the Member for Montgomeryshire (Glyn Davies) for his comments. One great strength of the House is that we can take a lead. Sometimes we might be frustrated that individually, as Members of Parliament, we cannot wave a wand and change something overnight, but we have the ability to access, influence, create platforms and shape the way people think. Within our constituencies and beyond, we have the ability to influence the way employers think, as the hon. Gentleman is undoubtedly seeking to do today. I commend the message that he is sending out. It is one that I hope Members will continue to send in relation not only to IBD but to the many fluctuating conditions that make people’s lives more difficult, although they should not and need not make it impossible for people to stay in the workplace. A bit of understanding from an employer can go a long way in preserving skills important to the organisation while giving employees the flexibility to deal with the challenges that they face.

However, for those who are struggling and finding that their employers are less supportive, which is bound to happen, we seek to personalise support for each individual through the work done by Jobcentre Plus and the Work programme. Along with both sets of organisations delivering support for the unemployed— our Jobcentre Plus offices up and down the country, and the different organisations working with the Work programme—we seek to individualise support as much as possible and ensure that we match individuals to employers.

One great way to overcome the challenges that people with different disabilities and health problems face in the workplace is by matching individuals to employers who understand, respect and support them. We encourage our Work programme providers and Jobcentre Plus offices to work closely with charitable groups for people who face different health challenges in order to ensure that organisations have the best possible understanding of the support that they need, so that we can do job-matching work to the best of our abilities.

In addition, where mainstay provision is not appropriate, we provide specialist support through Access to Work and Work Choice, which are available to the individuals with the most complex support needs. Each year, Work Choice aims to help about 9,000 people with disability and health problems into work, and Access to Work provides support to about 35,000 individuals.

I agree with my hon. Friend the Member for Brigg and Goole that it is essential for employers to make reasonable adjustments, which might include unrestricted access to toilets for people with IBD. It is common decency, and there is no earthly reason not to. I know we have not always moved beyond the world in which we have lived, but one would hope that in today’s world, not many employers would deny someone access to a toilet. I believe that in most of our economy—ideally, in all of it—that should be a management practice of the past. Employers now have a duty under the Equality Act 2010, and they are putting themselves at risk if they do not pay attention to an individual’s needs, if those needs are reasonable and sensible. I certainly regard unrestricted access to a toilet as being entirely that.

We are also trying to ensure that all those who work with us in the Department for Work and Pensions networks and who have a responsibility for health care—particularly health care professionals working with people undergoing the WCA and, in due course and Parliament permitting, the assessment for the new personal independence payment—have an understanding of the nature of the health conditions that they will confront in their work. The doctors and nurses working with us and Atos Healthcare on the assessments, for example, already have a knowledge of IBD from their professional training. However, those who are not from such a background—physiotherapists, for example—undertake a training module on inflammatory bowel disease as part of their work capability assessment induction. A learning set on continence, including a focus on IBD, is offered to health care professionals as part of the Atos Healthcare continuing medical education programme. To assist them in their knowledge of such conditions, health care professionals also have access to an evidence-based repository.

We try hard to ensure that we provide the people who work for us with access to information about fluctuating conditions, mental health problems and other issues that they will come across in their duties, so that they are as well placed as possible to be responsive in their decision-making and to get those decisions right. We have no interest whatever in getting such decisions about people wrong. This is about taking the right decisions and providing support for people who have the potential or are perfectly able to continue to work, and then finding the right employers for them. However, it is also about understanding the limits of an individual’s ability to work and ensuring that we do not end up making someone work who cannot realistically do so.

We are continuing to work to improve our knowledge, understanding and processes, and the responsiveness of those processes, for people with fluctuating conditions. In the past few months, our adviser on the work capability assessment, Professor Malcolm Harrington, has carried out a project in partnership with organisations that represent people with Crohn’s disease, IBD and other fluctuating conditions to enable us to understand better how we can improve our processes to ensure that we take well-informed, appropriate decisions. The group has made a number of recommendations to us through Professor Harrington. We are considering our response, but I have given a clear commitment that the Government will do everything that we realistically and reasonably can to improve the way we work and ensure that we take the right decisions.

It is important, too, to find the dividing line. That will always be a difficult challenge for any Government, because, as the hon. Gentleman has said, there are two sets of points. The first is about employment and the need to get things right for those in work, and the second is about the need to get things right in our benefits system for those who cannot work. Finding a dividing line between the two is very difficult. There is no simple black-and-white answer to the two sides of that problem. The Government must do everything we can in our assessments and judgments to make our decision-making as accurate as possible. There is no exact science, of course. When we come to that grey area, no individual on the borderline is definitely able or unable to work.

I give the hon. Gentleman every commitment that our goal is to get right what we do. In all our reforms, including the reforms coming through Parliament this week to which he referred, it is not our wish or intention to do the wrong thing by people who find themselves in a difficult position in their lives. We have to find the correct approach in one of two different routes. It might involve finding the right support to get them into work; it might involve getting them into the benefit system. However, what we are trying to avoid is sending people down the wrong route: for example, somebody with the potential to work who is not asked to do so, or somebody who has the potential to work but is not encouraged to do so.

All of our reforms are about taking the right decisions, as far as we possibly can, by those individuals, and providing support, knowledge, and understanding for people with such conditions. We will not always get it right, but we will do our best to do so, and to deepen knowledge and understanding right across the workings of the DWP about IBD and other fluctuating conditions suffered by the people whom we seek to help.