Work Capability Assessments

Debbie Abrahams Excerpts

Tuesday 9th February 2016 Westminster Hall

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

May I reiterate what other people have commented—that it is lovely to see you in the Chair today, Mrs Moon? I congratulate my hon. Friend the Member for Sheffield, Heeley (Louise Haigh) not only on securing this debate but on an excellent speech; it really was very informative.

We have already heard a number of Members say that the current work capability assessment, which was introduced under the coalition Government, is failing on a number of counts and needs to be overhauled. I share the view of the hon. Member for Banff and Buchan (Dr Whiteford) that the fact no Government Members have spoken, and the imminent White Paper, suggest that the Government are finally getting it. I really hope that is the case. However, I need to reiterate some of the points that have been made about why the Government need to think again.

The WCA needs a complete overhaul. It is not fit for purpose, and we have heard that it is failing to assess a person’s fitness for work, or work-related activity, accurately or reliably. We have heard the figures about appeals. More than half of people—54%—who appeal against a decision that they are fit to work have the decision overturned. We have also heard about how the costs of the WCA have spiralled out of control, which reflects the woeful performance. Obviously, the National Audit Office report last month was very damning indeed, although I have to say that it came several weeks after it was clear what was going to happen.

Fundamentally, the WCA fails the most important requirement of any Government policy—that it will not knowingly harm citizens. For almost a year now, the Government have obfuscated and tried to evade revealing the toll that the WCA process is having on the people being subjected to it, even after stark warnings from the Select Committee on Work and Pensions. The mounting evidence against the WCA cannot be ignored any longer; hopefully the Government are listening to it.

There have been five independent reviews of the WCA since 2010. The Work and Pensions Committee undertook two of them in the last Parliament; I was pleased to be serving on the Committee when it undertook the review in 2014. The most recent report from that Committee included evidence taken from the reviewers, who warned the Government that in spite of all the reviews that had happened before—Professor Harrington and Dr Litchfield have produced reviews—the process was still flawed. They said that people with progressive and fluctuating conditions, such as Parkinson’s, were particularly likely to fall foul of the process. I will never forget taking evidence from people in Newcastle as part of that Select Committee inquiry in 2014 and hearing their personal testimonies. The evident pain and humiliation that they had experienced as part of the process was quite shocking.

Like other hon. Members we have heard from today, I have had evidence from my own constituents. A man who came to see me had a serious heart condition. In a WCA, he was told by the nurse undertaking it that he was in the process of having a heart attack; that was how stressful the WCA was. He was told to go to hospital, but two weeks later he received a letter telling him that he had been sanctioned because he had left the WCA. There are similar examples up and down the country.

The former chair of the Work and Pensions Committee, Dame Anne Begg, spoke on the issue and said:

“When my constituent, who has lost his job because he has motor neurone disease, scores zero on his WCA and is found fully fit for work, there is something wrong with the system. When that same constituent appears in front of a tribunal and in less than five minutes is awarded 15 points”—

that is the maximum score, which means the person is completely unfit for work—

“there is something wrong”.

I hope that we are seeing a different view from the Government now, but in their response to the Work and Pensions Committee at the end of 2014 they were having none of its report; there was the usual rhetoric. I would be interested to know what the Minister would say today if Dame Anne’s former constituent was standing here in Parliament now.

The Committee said that simply rebranding the WCA by taking on a new provider would not work, and it recommended a complete overhaul of the system. We still believe that that is needed, and such an overhaul is Labour party policy; I have said that consistently since my appointment to the Front Bench. What is required is not just a process to determine eligibility for employment and support allowance but an examination of health-related barriers to work. I agree with the hon. Member for Banff and Buchan that we need to look at the international data. I know that work has already been done to compare different processes, and adopting a more personalised and holistic approach is important. I remember producing such a piece of work before I came to the House, and there are lessons to be learned from elsewhere. However, as I have said, at the time of the Select Committee inquiry, the Department for Work and Pensions was not particularly inclined to consider those lessons.

When the Minister responds to the debate today, I am sure she will talk about the new work and health unit. However, I would also like her to describe, if she can, the discussions that the Government have had with the royal colleges, because I have some concerns. For example, the Royal College of Psychiatrists has raised the issues of medical ethics, treatments and interventions, the principle of consent, and the qualifications of the staff involved in WCAs. I would be grateful if she referred to those points in her wind-up.

My next point is about poor performance. We know that last month’s National Audit Office report reiterated that the WCA is not only unfit for purpose but poor value for money, as many of my hon. Friends have already mentioned. The Government have failed in their fiduciary responsibility to ensure that taxpayers’ money is spent wisely. They have failed to monitor and performance-manage work capability assessment contracts and hold the providers to account.

The NAO report stated that under contract with the Centre for Health and Disability Assessments, which is a subsidiary of Maximus, the cost of each assessment has risen to approximately £190, compared with £115 under the previous contract with Atos. If that was an investment in greater efficiency and a smoother process, one might possibly say that it was value for money, but the NAO described the performance output issues, with a backlog of 280,000 assessments and the contractor not being expected to meet its performance targets for last year.

The NAO went on to describe how the Department for Work and Pensions was struggling with target setting and had failed to test bidders’ assumptions during the tender process—for example, on staff recruitment and training. Will the Minister describes how that is being addressed? After six years, it is a real problem if we are trying to ensure that we live within our means.

The biggest indictment of the Government’s work capability assessment process is the potential harm it does to people who are put through it. As we have heard, last November the University of Liverpool and the University of Oxford published a study in the Journal of Epidemiology & Community Health. It is a peer-reviewed journal, and papers with Mickey Mouse statistics are not published in such journals—they would not be tolerated. It is a robust—[Interruption.] I hear some chuntering from the Government Benches. These are robust data; papers would not be allowed if the data were not robust—[Interruption.] There is still chuntering, but I will carry on. That study showed that between 2010 and 2013 the Government’s work capability assessment regime was independently associated with an additional 590 suicides, 280,000 cases of self-reported mental health issues and 725,000 antidepressant prescriptions.

The Royal College of Psychiatrists has raised the concern that, for people with mental health conditions, the work capability assessment process can cause a relapse, thus hindering rather than helping in their recovery. Just before I came to the debate I was provided with a list of coroners’ reports containing concerns that the deaths, including suicides, were associated with the work capability assessment. I am particularly concerned about the case of Stephen Carre, which has already been mentioned, in which the coroner wrote to Ministers and the Department and apparently did not receive a response, as required by law. I would be grateful for the Minister’s response to that point.

The findings reported in the paper in the Journal of Epidemiology & Community Health—in a paper entitled “First, do no harm”—came on top of published data relating to the deaths of incapacity benefit and ESA claimants between November 2011 and May 2014. The Government were compelled by the Information Commissioner to publish those figures. At the end of April, an appeal went to that body, which ruled in favour of the appellant and required the Government to produce the figures. But when did they produce them? Just before the end-of-August bank holiday.

The figures showed that the overall death rate for people on IB or ESA was 4.3 times higher than in the general population—an increase from 3.6 times higher in 2003. People in the support group are 6.3 times more likely to die than the general population, and people in the work-related activity group, from whom the Government want to take £30 more a week via the Welfare Reform and Work Bill, which is going through the House, are 2.2 times more likely to die.

The Government’s innuendo that people with a disability or illness might be “faking it” or are “feckless” or, as the Prime Minister said shockingly last week, are “making a lifestyle choice”, is grotesque and belies the epidemiological data. IB and ESA are recognised as good population health indicators, in that they reflect areas with an industrial backgrounds and areas of poor health.

[Neil Coyle]

My hon. Friend describes the impact on people. One of my constituents has referred to it as the Secretary of State adopting a pterodactyl style of management, flapping around high above, making a lot of noise and—pardon the expression—dumping on the little people down below. Does my hon. Friend share that view?

[Debbie Abrahams]

I would not put it in quite those words, perhaps, but I know exactly what my hon. Friend is getting at.

The Government’s own data show that the people involved are sick and disabled. They need support; they do not need vilification. Unfortunately, that is too often what happens, as at last week’s Prime Minister’s questions.

Being disabled or being ill is not a lifestyle choice. Alarmingly, we now hear reports of people in the ESA support group—people who have been found not fit for work, including people who are terminally ill—being required to go to work-focused interviews. The Minister might be aware of that. We have evidence only from England so far, but I would be grateful if she gave us an explanation.

For me, that latest revelation says it all. It is about cuts for disabled people and the seriously ill. The Government are not content with having cut £23.8 billion from 3.7 million disabled people since 2013 under the Welfare Reform Act 2012; they are going for more cuts, and the work capability assessment and the Welfare Reform and Work Bill are another way of achieving them.

The Government have tried to regenerate the economy on the backs of the poor and disabled. Their modus operandi is division and blame, deserving and undeserving. Like the NHS, our social security system is based on principles of inclusion, support and security for all, assuring us all our dignity and the basics of life should any one of us become ill and disabled. The Government need to remember that and stop their attacks on disabled people.

[Mrs Madeleine Moon (in the Chair)]

Before I call the Minister, I remind her to allow two minutes at the end for the mover of the motion, Louise Haigh, to have the opportunity to respond. I call Priti Patel.

--- Later in debate ---

[Priti Patel]

I cannot speak specifically to previous contracting processes and bids that took place outside the United Kingdom—it is not for me to comment on—but let us be clear. The Department is responsible for hundreds of billions of pounds of public money—taxpayers’ money. On our processes of procurement, renegotiation and accountability, we have a clear approach to the scrutiny of providers, and rightly so. That applies to all Departments, and the same applies when it comes to failure. The contract has an open-book accounting approach and a robust validation of data. I think the hon. Lady mentioned falsification of data at one point. We have a clear process on the validation of data. She also went on to comment on how providers are incentivised, but our providers are not incentivised by benefits outcomes. We have a full range of balanced performance measures that focus on quality and volumes and customer satisfaction. That brings me back to the fact that we are speaking about people and how the interaction with people through assessments actually takes place.

Performance reviews and performance are fundamental in all Government contracts to ensure governance arrangements, and the Department takes steps to implement regular weekly and daily meetings with DWP officials and the CHDA.

[Debbie Abrahams]

Will the Minister give way?

[Priti Patel]

I will give way, but I want to emphasise that service credits are applied when a supplier does not meet an agreed service level.

[Debbie Abrahams]

I am grateful to the Minister for giving way and for her response so far. Will she tell us whether there is a requirement in the tendering process for disclosure of previous legal action?

[Priti Patel]

I cannot answer that question, but I will find out and write to the hon. Lady. I would be astonished if the Department did not have a system for looking back and assessing companies’ previous conduct before we engage with them. All bidders have to be thoroughly scrutinised by not only my Department but others. Much of that work is done with the Cabinet Office, which sets out guidelines and guidance. I have no doubt that the right systems and efficacy procedures are in place for contracting and the types of contractor with which the Government engage.

Bidder’s assumptions are tested as part of the negotiated procedure, and they are provided with information as part of the dialogue that takes place. The WCA contract was originally with Atos. Since the CHDA has picked up the contract, there have been challenges and backlogs, which have been referred to throughout the debate. It is only right that the Department continues to address those challenges and sets stretching and ambitious targets for its providers. We will ensure that we deliver value for money for our contracts. Again, the assumptions are tested through the bid process, but we are clear that a new financial support model has been in place as part of the CHDA contract. We have also contracted for a more sustainable service, part of which includes more face-to-face assessment—that direct engagement which did not take place under the previous contract. The focus is also very much on reducing the backlog and improving waiting times.

The NAO report has been mentioned several times. The report recognised that the Department has made particular progress and acknowledged the fact that there is now a relentless focus on performance when it comes to reducing backlogs and driving down delays. It also recognised the increased performance management capacity. Although there is more to do—we can never stand still in this space—we have learned from our experiences in the contracting process and will ensure that we continue to make improvements.

A number of Members mentioned cases from their constituencies. I would, of course, be happy to look at any individual cases that Members would like to refer to me, but I should emphasise that we clearly do support people through the system. A great deal of money has been put into providing support to help people to go back to work. Over the next three years, £43 million is being invested in trialling the provision of specialist support for people with mental health conditions. The Government also recognise the importance of promoting positive attitudes among employers when it comes to them employing people with disabilities or health conditions. That will be at the heart of the White Paper that will be published—

--- Later in debate ---

[Priti Patel]

I acknowledge that there is more to do to support people with health and disability issues. In the recent spending review, we outlined our commitment to support people with disabilities into work. We announced a real-terms increase in funding for Access to Work, which will enable up to 25,000 additional disabled people to receive support. We will expand the Fit for Work service to support more people on long-term sickness absence with return to work plans, and we will provide at least £115 million for the new joint work and health unit, including £40 million for a work and health innovation fund. We will set out some new long-term reforms in the White Paper, which will be published in the spring.

This is about not reinventing the wheel, but learning from insights. Hon. Members spoke about evidence, support and insights from charities, stakeholders and third parties, which the hon. Member for Banff and Buchan mentioned. My Department is working with stakeholders through the joint work and health unit, and a new taskforce has been set up to gain insights into providing support for individuals in a more targeted, tailored and personalised way. If people are assessed and put on a benefit, we do not want there to be no dialogue and interaction with them during that period about the additional support that they require to get back into work. The White Paper will be published in the spring, but we are open to thoughts and comments through the consultation process.

This not just about the WCA; we must have a much more holistic approach to supporting individuals. Before the Division, I mentioned employers, and there is a lot more that can be done to promote positive attitudes to employing people with disabilities and health conditions. Employers must find the right balance and the right way to support people in the workplace. For example, they can utilise occupational health and look at our Disability Confident campaign and the work that my hon. Friend the Minister with responsibility for disabled people is doing.

Looking at this issue holistically, our reforms are all aimed at improving the quality of life of those who need the support the most. It is right that we recognise that there is no single method for each individual and their particular circumstances. Every person in the benefits system is an individual and their situations will be different, difficult and challenging. No system can offer a one-size-fits-all interaction, but we must ensure that the system works with individuals and recognises their particular backgrounds and circumstances. Protecting the most vulnerable in society is this Government’s priority.

[Debbie Abrahams]

Given that 90% of disabilities are acquired, I recognise and support all that the Minister has said about ensuring that people can stay in work as much as possible and that people are helped back into work, but that does not currently happen. Some half a million disabled people will be affected by the change in the employment and support allowance and the cuts. How can the cuts be justified before the support to enable people to stay in or get into work is in place?

[Priti Patel]

The hon. Lady mentioned the current changes and referred to the Welfare Reform and Work Bill that is being considered in the House of Lords this afternoon. She will recall that this issue was debated extensively in Committee. I have emphasised that the Government have a clear commitment to protect the most vulnerable in society, including disabled people. No one who is currently in receipt of ESA will see a financial loss; the changes will not affect anyone whose capacity to work is significantly limited. The personal independence payment will also continue to help meet the extra costs of living that disabled people face, and exempted benefits contribute to the additional costs of disability and care resulting from the benefits freeze.

Looking at the debate holistically, we know that the WCA has caused many previous challenges. Yes, reforms are coming and, yes, changes are afoot, but I think hon. Members will agree that we cannot write off the people who, for various reasons, have not been supported into work. If they can work, we want to support and encourage them.

The Government spend a great deal of money on protecting the vulnerable not only through benefits, but through additional support to help with living costs. It is right that we provide that support and safety net. I hope that future debates and the White Paper will help to introduce new suggestions, new ways of working and new practices to ensure that we do not again see the situation that we had in 2008, 2009 or 2010 with Atos and the WCA. We should broaden the interface of support available through not only agencies or Government Departments, but specialist support organisations, stakeholders, practitioners and those in the care sector, recognising that we can always do more to support people. I am conscious of the time, Mrs Moon, so I will close my remarks there.