Work Capability Assessments

David Linden Excerpts

Wednesday 13th December 2017 Westminster Hall

[David Linden (Glasgow East) (SNP)]

I beg to move,

That this House has considered work capability assessments.

It is good to see you in the Chair, Ms McDonagh. I am really grateful for the opportunity to raise this issue in Parliament today, as flawed work capability assessments have been a major topic in my case load since my election in June this year.

May I start by thanking the many charities, organisations and individuals who have reached out to me in the run-up to this debate with an offer to share briefings and information about their experience of work capability assessments? It is only appropriate at this juncture to commend the hard-working staff in the House of Commons Library for the excellent briefing that they have supplied to all right hon. and hon. Members. I am immensely grateful to individual members of the public from across the UK who got in touch to share their own, often harrowing, experiences of undergoing assessment and the sheer distress caused to them. Time will not permit me to share every testimony, but I want to share some case studies with the House this afternoon, and I am sure that other hon. Members will wish to do the same.

From my short time as a constituency MP, it has become abundantly clear that the UK Government’s work capability assessment is not fit for purpose and requires a full, independent, root-and-branch review to ensure that it treats people with dignity and respect. As it stands, the system is failing the most vulnerable in our society and all too often plunges people into chaos and depression, and in some cases, I am afraid, to the brink of suicide.

I therefore very much welcome the decision of the Select Committee on Work and Pensions to carry out an inquiry into personal independence payment and employment and support allowance assessments. What I do not want to see, however, is a powerful report coming from the Select Committee, only for it to be ignored by the Government, as happened in late 2014 during the last inquiry. The evidence and testimony that the Committee has already received should be sounding the alarm bells at Caxton House, and that is before the Committee has even published its report.

I very much welcome the Minister to her new role. As she knows, I enjoyed a constructive working relationship with her predecessor, particularly on the campaign to end the baby benefit bar. The Minister is widely respected across the House and I have no doubt that she will be in listening mode today. I therefore hope that she will approach this sensitive topic with fresh eyes and the compassionate conservatism that we have heard so much about from the Government.

I will outline some of my major concerns about the work capability assessment process, including the number of claimants with serious health conditions or disabilities who are found fit for work or placed in the wrong ESA group because of deficiencies with the WCA descriptors or in the assessment process.

[Mr Jim Cunningham (Coventry South) (Lab)]

I think that there are two issues here. One is that private companies are not necessarily equipped to assess people. Secondly, the questionnaire form can give enough information that it does not necessitate an interview of the kind handled by private companies.

[David Linden]

I am grateful to the hon. Gentleman for that intervention, and I will come to that point in a moment.

I will talk about the difficulties faced by certain groups, in particular people with mental health conditions or learning disabilities, in navigating the WCA process; the lack of information about outcomes for individuals following fit for work determinations; and concerns about the risk of poverty and destitution as a result of incorrect decisions. I also want to touch on the relatively high success rate of appeals against ESA decisions, and the difficulties experienced by claimants seeking to challenge fit for work decisions, including the fact that ESA is not payable pending a mandatory reconsideration, meaning that the only option in the meantime is to claim jobseeker’s allowance, potentially exposing an individual to inappropriate conditionality.

[Mr Stephen Hepburn (Jarrow) (Lab)]

The hon. Gentleman mentioned mandatory reconsiderations. Is he aware that Department for Work and Pensions staff are informing people that mandatory reconsiderations will be delayed over Christmas because of the excess workload they face? Through him, can I ask the Minister to transfer staff from bringing in the sanctions and stopping the money, to the mandatory reconsiderations, so that people get their money?

[David Linden]

I know that the Minister is respected across the House for listening; I am sure she will have heard that point, and I hope the hon. Gentleman gets an answer to it in the wind-ups.

Finally, I will touch on the impact of assessments, frequent reassessments and poor decision making on the physical and mental health of claimants. We could easily spend the next hour and a half trading statistics across the Chamber, but I prefer to focus on real people and those whom I have been elected to represent. Throughout my short time as Glasgow East’s MP, I have seldom had a surgery in which a constituent has not come to me having been the subject of a flawed work capability assessment.

One such case was that of my constituent, David Stewart from Baillieston. David suffers from hidradenitis suppurativa and has had numerous abscesses over the years requiring extensive surgery and skin grafts. It is not uncommon, at times, for him to receive morphine up to six times a day. His own general practitioner stated clearly that David should not be working, yet he was found fit for work at a work capability assessment. It was only after my office intervened and helped him draft a mandatory reconsideration that that decision was finally, and justly, overturned. That brings me to the first issue I want to raise with the Minister today: the astonishingly high level of successful appeals against work capability assessment decisions.

[Stephanie Peacock (Barnsley East) (Lab)]

In my constituency, two thirds of residents who are initially rejected for PIP and ESA are shown to be eligible on appeal. Does the hon. Gentleman agree that that suggests the whole work capability system requires much more reform?

[David Linden]

The hon. Lady makes a good point; I very much agree.

The latest quarterly release on appeals of work capability assessments shows that 59% of decisions are overturned at appeal. To be blunt, that means that six in every 10 decisions are wrong. That is incredibly alarming.

There is, of course, a wider point about the undertaking of work capability assessments by a private sector provider, which I oppose on ideological grounds—I agree with the hon. Member for Coventry South (Mr Cunningham) on that point. I doubt, therefore, that it will come as much surprise that I very much welcome the commitment by the Scottish Government to ban private firms from carrying out benefit assessments. I wholly concur with the Scottish Social Security Minister Jeane Freeman, that

“profit should never be a motive nor play any part in assessing or making decisions on people’s health and eligibility for benefits.”

Over and above my ideological objection to private sector provision, I am sure that all hon. Members will be concerned to note that, according to the DWP’s own data released only last week, the ESA assessment provider has consistently failed to meet the contractual expectation for the quality of assessment reports.

[Helen Whately (Faversham and Mid Kent) (Con)]

One thing I have been calling for, for some time, is standard recording of all work capability assessments. Often there is one story from one side and another story from the other, and recording would not only provide some evidence about what really happened, but improve people’s experience of the assessments. It has been piloted, so does the hon. Gentleman agree that it would be good to push forward with the recording of assessments as one way of improving the experience for our constituents?

[David Linden]

I am grateful to the hon. Lady and will come back to how the assessments are conducted, because that forms a major part of my speech.

At this juncture, I want to commend to the House the excellent report by Rethink Mental Illness entitled “It’s broken her”. It was published just last week and makes truly harrowing reading. The report lays bare the full extent of the challenges for people with mental illness when facing assessments for both ESA and PIP. Drawing on findings from a series of interviews and focus group-style discussions, the report finds that the assessment can be “traumatising and anxiety-inducing” for the following reasons: there are numerous issues with the paper forms that claimants must submit, including their complexity and length, and the inflexible nature of the questions they ask; claimants must collect their own medical evidence, which is extremely burdensome, often expensive and time-consuming; the staff who perform face-to-face assessments frequently have a poor understanding of mental illness; and, finally, delays in mandatory reconsideration and appeals to the tribunal mean that claimants may have to wait many months for the correct result.

The report concludes that the current PIP and ESA assessment procedure

“inherently discriminates against people with mental illnesses”.

It sets out a number of policy recommendations to

“dramatically improve the benefits system for people with mental illnesses, as well as saving the Government the vast costs that are currently incurred due to persistent incorrect decisions made early in the process.”

[Tommy Sheppard (Edinburgh East) (SNP)]

My hon. Friend is making a powerful case. May I bring to his attention the case of my constituent, Adam Brown, a 51-year-old man who suffers from epilepsy and cerebral palsy and has a learning disability? By the time Adam came to see me, he had been trying to get a work capability assessment for nine months with the assistance of benefit agencies, and had not got it. We had to intervene and got it within 10 months. It is surely shocking that it takes the intervention of a Member of Parliament for people with disabilities to get fair treatment.

[David Linden]

My hon. Friend makes a powerful point. I am glad that his office was able to help on that occasion, as mine was in the case of my constituent David Stewart. It is all well and good that as Members of Parliament we can intervene in individual cases, but so many people are affected throughout the entire process that our being able to help on a one-off basis is not good enough.

[Mr George Howarth (Knowsley) (Lab)]

The hon. Gentleman is making a fluent and powerful case. Does he agree that if there is a review of the process, two things need to happen? First, in clear, medically proven cases of mental illness, the medical evidence should be accepted without face-to-face examination. Secondly, the assessors and decision makers should be appropriately trained in mental health.

[David Linden]

I am grateful for that intervention, which leads me on to the recommendations of the Rethink Mental Illness report. The first is:

“A major reform of the PIP assessment and the WCA for ESA is needed. This should result in both assessments reducing the distress caused to people affected by mental illness and that better reflect the realities of living with a condition of this type. Such reform would reduce the need for appeals and the associated costs to the DWP and HM Courts & Tribunals Service”.

The second recommendation is that, as the right hon. Gentleman argues,

“The Government should review the way in which people with mental illness are assessed. Where clear medical evidence exists that claimants have severe forms of mental illness, they should be exempt from face-to-face assessments. Where face-to-face assessments are necessary, claimants should be encouraged to seek support from carers, friends or family members.”

I have seen numerous examples of friends, family members and carers being taken along, only to be told that they are not allowed to help.

The third recommendation is:

“All assessors and DWP decision-makers should be appropriately trained in mental health. The scandal of inappropriately trained and experienced assessors making critical decisions about the lives of people affected by mental illness must end.”

One case study in the report caught my eye, and I want to share it with the House. James, who was 53, had a work capability assessment with a physiotherapist after he lost his job because of depression—not that I can see the connection between physiotherapy and depression. This is his testimony:

“The assessor wanted yes or no answers to various questions like ‘can you leave the house?’ I tried to explain that some days I can leave the house or answer the door, and other days it’s not possible because of my mental health, and the response from the assessor was ‘is that a yes or a no then?’

I have no problem when people don’t understand mental health; it’s when they have an opinion on something they don’t know anything about.

There weren’t any specific questions exploring my mental health. At the end of the assessment, the assessor asked me to touch my toes, and I felt that the whole assessment was set up so people with mental illness fail.”

[Dr David Drew (Stroud) (Lab/Co-op)]

Does the hon. Gentleman agree that one of the problems with the process is that it lumps mental health conditions together? Epilepsy is a very different condition from depression, for example, yet people with mental health conditions all undertake the same assessment. Surely that is not fair or right.

[David Linden]

The hon. Gentleman is absolutely right.

The quotation from James ends:

“I came out of the assessment feeling let down, and not listened to, and later I made two attempts on my life. I’m still waiting for the result of my WCA.”

That should certainly sound alarm bells in this House. Closer to home, Michelle Ferns, a member of my constituency casework team, has a profoundly autistic son, Richard, who is non-verbal. During Richard’s assessment, Michelle was asked by the professional—the professional!—whether Richard still had autism. That is the kind of ridiculous behaviour that we are seeing in the process.

An ongoing case that I would like to press with the Minister is that of a constituent from Tollcross; I hope you will indulge me, Ms McDonagh, because it relates to a PIP assessment rather than a work capability assessment. My constituent was diagnosed with multiple sclerosis seven years ago. She is fiercely independent, but in the past two years her memory and physical mobility have declined steadily. She was awarded the standard rate for PIP but nothing for the mobility component. She submitted a mandatory reconsideration but, despite new information, it was still rejected. As a constituency Member of Parliament, I am certain beyond doubt that the wrong decision was made in that case, and I will be writing to the Minister to ask her to intervene personally and review it.

At this juncture, with a sense of trepidation, I must ask the Minister whether she has ever sat in on a work capability assessment. When I asked the Secretary of State that question in the main Chamber two weeks ago, I was quite shocked to learn that in his seven years as a Minister, he had never sat in on a work capability assessment.

[Mike Hill (Hartlepool) (Lab)]

The hon. Gentleman is making an excellent speech, particularly with respect to mental health, which is one of my specialities. In my constituency, Hartlepool, a man waiting for a double kidney transplant was declared fit for work despite having to make four trips a week to his local hospital. Does the hon. Gentleman agree that such cases are abhorrent?

--- Later in debate ---

[David Linden]

Yes. The hon. Gentleman’s point is very valid; his constituents are lucky to have such a strong representative.

Getting a work capability assessment right is vital. Wrong assessments can mean that people with a learning disability are moved to a benefit such as jobseeker’s allowance, which makes many demands that are often difficult for people with a learning disability to understand or fulfil. As a result, they are put at risk of being sanctioned.

Yesterday, Muscular Dystrophy UK shared with me the awful story of a lady with Charcot-Marie-Tooth disease who was deemed ineligible for ESA after a work capability assessment. The content of the questions resulted in the entire assessment missing several key points about how her condition affected her, such as the loss of dexterity in her hands and her inability to lift her arms above her head or use buttons. No consideration was given to the pain or fatigue she experiences daily. Many people like her are not adequately assessed during the work capability assessment because the questions that relate to its criteria are not suitable to extract the information required to help the assessor in understanding progressive conditions such as muscular dystrophy. With universal credit on the horizon, particularly in Glasgow, what plans do the Government have to alter the questions to be more appropriate and relevant for people with rare and complex conditions?

Some commentators have suggested reforming the work capability assessment to take account of how people’s functional impairments affect their ability to work, given who they are. They argue that a broader “real world” assessment that took into account factors such as skills, qualifications, experience and age would be possible and would better reflect everyday realities than the existing work capability assessment. To that end, I commend to the Minister and all hon. Members some reading for the Christmas recess: Demos’s March 2015 report “Rethinking the Work Capability Assessment”.

I am conscious that time is marching on, and I want to allow fellow Back Benchers the opportunity to speak, so I should wrap up.

[Hugh Gaffney (Coatbridge, Chryston and Bellshill) (Lab)]

The hon. Gentleman mentions capabilities with reference to individuals. Is the Health and Safety at Work etc. Act 1974 also included in those capabilities when assessments are carried out?

[David Linden]

That is a very good question. I am sure that the hon. Gentleman, my constituency neighbour, will press that point with the Minister.

I am grateful to all hon. Members attending the debate. I especially thank the Minister for listening this afternoon; I have a huge amount of respect for her, and I look forward to her winding-up speech for the Government. However, what I want from the Government is deeds, not words. I want a full root-and-branch review of the work capability assessment process, and I want an assessment that is underpinned by professionalism, knowledge, dignity and—above all—respect.