ESA and Personal Independence Payments

Debbie Abrahams Excerpts

Wednesday 30th November 2016 Westminster Hall

[Justin Tomlinson (North Swindon) (Con)]

It is a pleasure to serve under your chairmanship, which seems almost a daily occurrence this week, Ms Dorries, given the Bill Committee I am also serving on. I pay tribute to the hon. Member for Lanark and Hamilton East (Angela Crawley). This is an important debate and a topic that regularly comes up, particularly in this room, which shows the importance of Westminster Hall. We are fortunate that we have a Minister who is very engaged and proactive when it comes to listening—particularly when the system is not quite working as it is intended to—and when it comes to acting and working with experienced charities, policymakers and all sorts to bring us all together. What we all want, regardless of which side of the House we sit on, is a fair system that supports the most vulnerable in society. It is a pleasure to follow the hon. Member for Strangford (Jim Shannon), who, during my time as a Minister, was really proactive and constructive on this issue. I had many good meetings with him to discuss specific issues and lessons we could learn from Northern Ireland, and to share best practice.

Two issues have been raised: PIP and ESA. I gently remind Scottish National party Members that Scotland could take responsibility, certainly for PIP. During my time as a Minister, I had a good relationship with my counterpart in the Scottish Parliament. He was aware that Scotland could take on that responsibility as and when it was ready.

Some 1.8 million people have already gone through the PIP process, which is considerably better than the old DLA system, and that is widely accepted by the vast majority of charities who represent people who have been through the system. Under DLA, only 16% of claimants got the highest rate of the benefit. Under PIP, it is 23.5%. It is far better at identifying hidden impairments and fluctuating health conditions. For example—this has been highlighted in the two previous speeches—under DLA, only 22% of those who had a mental health condition accessed the daily living component, yet under PIP, 66% did. For the higher rate of mobility, it was 9% under DLA; it is 24% under PIP.

The new system is far better and more streamlined. The assessors are there to help people to fill in the forms. The fundamental problem with DLA was that it was, in effect, self-diagnosis. People would fill in a very long, complicated form. A lot of people did themselves an injustice by not highlighting all the issues they faced, often because they took them for granted. For example, they might think, “I can’t sleep at night. That’s just the way it is”, but they did not then highlight that in their forms. The forms were complicated, so people would not necessarily know which were the right bits to put down.

Even worse, 70% of claimants on DLA had an indefinite award. It is very attractive for MPs to say, “We don’t want anybody ever to go through an assessment”, but the reality was that, under DLA, 70% did not. That sounds great, yet one in three claimants’ condition changes so significantly within 12 months that they should be on a different benefit. The vast majority of people who go through the system have a deteriorating condition, so if their condition has changed, it has probably changed for the worse and it is highly likely that they would therefore go from the lower rate to the higher rate of benefit.

That was the single difference that contributed to why, under DLA, only 16% of claimants got the highest rate, and 23.5% get it under PIP. There were people who, for 10 or 20 years or more, were on a benefit below that which they were entitled to. They were unaware that they could have had an opportunity to go up. It is right, therefore, that we assess people to ensure that they are given the correct benefit.

Now, common sense kicks in. If someone is on the highest rate of benefit, they have a deteriorating condition. Unless there is some miracle cure, they are likely only to be reassessed at the end of the 10-year period, and it would probably be very light touch. In effect, someone would phone and ask, “Has there been a miracle cure?” The answer would probably be no, and they might ask, “Can you provide the GP’s evidence that there has not been a miracle cure? That’s fine. You will go through.” It is those who are on the cusp of going from the lower benefit to the higher benefit who will have another assessment. The system is programmed to say, “This person nearly meets the highest rate of benefit. I suspect they will need it in nine months’ time.” It will automatically trigger a reminder to people that there is a reassessment, so they are not left languishing. I urge hon. Members to be careful in trying to stop people having an opportunity for an assessment.

In cash terms, in 2010, DLA delivered £12.7 billion of benefit support. The combined DLA and PIP is now at £16.6 billion. When the scheme was first launched, the time until assessment was terrible. We had lots of debates here on that. I was not the Minister then, but I was warned when I first went into the role that we would have almost weekly debates. Some people were waiting up to a year for their assessment. That was unacceptable. For nearly 18 months now, it has been in a settled state, taking about seven weeks for an assessment and 13 weeks for the whole process, end to end, which is well below the initial target of about 16 weeks. Again, charities and those with a huge amount of experience accept that the system is working well. The forms have been streamlined. They are still longer than we might like, but it is always a balancing act because, if we do not capture all the information, people could miss out on the benefit they need. I repeat that the assessors are there to help the claimant. The Government set the amount of money and the points that are required, but the assessors are there to ensure that the form is completed.

I have sat through assessments, and I have seen two different extremes. I saw the assessment of a practising nurse, and the assessment was super-quick. They used lots of very long words of which I had no understanding, and they were able to breeze through. At the other extreme, I saw an individual for whom English was not his first language. He had a mental health condition and was socially isolated. If he had self-diagnosed under DLA, he would not have qualified, but the assessor spent one hour and 10 minutes teasing out and piecing together the jigsaw to make sure that all the challenges he faced in his everyday life were accurately reflected. He would have ended up getting a higher benefit than he would have received under DLA.

I urge those who criticise the assessments to go and view one, which can be arranged. They will have their eyes opened, because too many people claim knowledge based on a film that is there to make money, rather than based on the real world. Frankly, that is an insult to the huge amount of hard work that these trained professionals do to help some of the most vulnerable people. The facts are there to compare DLA with PIP.

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

Rather than commenting on the film, which is a dramatic portrayal, will the hon. Gentleman comment on the “Dispatches” programme? That was not fictional; it was an actual portrayal of the assessment process that people go through.

[Nadine Dorries (in the Chair)]

Mr Tomlinson, the same applies to you as applied to Mr Shannon.

[Justin Tomlinson]

I will not be long. I am glad that the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) intervened. I have a feeling that she will not let me intervene on her later, so I can link this in nicely. The “Dispatches” programme showed an isolated incident that was totally unacceptable. The individual was moved, and rightly so. That is why we have external inspectors. Remember that we are talking about 1.8 million people, and I urge her to take up my invitation to go and view an assessment. Hearsay is not the right way to hold Governments to account. This is so important that people in positions of responsibility need to invest some time in going to see what is actually happening.

[Debbie Abrahams]

That is patronising.

[Justin Tomlinson]

It is not patronising. This is an important subject.

There have been further improvements, including the removal of the 28-day rule for terminally ill people. That cross-party campaign has made a huge difference to those who are terminally ill, and it is a welcome measure. There is ongoing training, and I would like to see automatic recordings of all assessments, which would help the appeals process. That requires a change in the contract, which I understand is the intention.

It is also right that assessors now encourage people to bring somebody with them into the assessment, which is particularly helpful for people who are not necessarily articulate, for whom English is not their first language or who would not have the confidence to display all their challenges.

As the hon. Member for Lanark and Hamilton East said, the ESA and PIP assessments are not a million miles apart. I have too often heard of cases where someone has done one assessment one month and the other assessment the next month. In respect of the Green Paper, many organisations will lobby for some serious data sharing.

In conclusion, because I have focused on PIP, I will briefly address ESA. The Green Paper is a wonderful opportunity, as the charity Scope said, because disabled people need “expert, tailored employment support”. We need to focus on what individuals can do, rather than on what they cannot do. It is important to provide tailored support, to recognise that people have fluctuating health conditions and to utilise the best parts of the universal credit system to allow for flexibility and common sense, particularly in relation to voluntary work that builds confidence to get people back into work. We need to provide ongoing support, through a specific named coach, when people go into work for the first time. I will continue to pitch, as a matter of importance, the small employer pilot, which was so successful that it should be rolled out across the rest of the country as quickly as possible. We need to unleash the opportunity for disabled apprentices. Everyone agrees it is a great thing, and we have signed it off. We now need to see it making a real difference, particularly for those with a learning disability.

--- Later in debate ---

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

It is lovely to serve under your chairmanship again, Ms Dorries. I congratulate the hon. Member for Lanark and Hamilton East (Angela Crawley) on securing an excellent debate. It has been really constructive and has brought to light more cases to show the Minister and the former Minister, the hon. Member for North Swindon (Justin Tomlinson), how people experience the cuts, how sick and disabled people experience the assessment process and the indignity they too often face. I wish Donna all the very best and I hope she continues to recover. It is the personal stories that bring this issue to life.

I thank all hon. Members who have contributed so well today—I should have started by saying happy St Andrew’s day. It is so important to understand what people are going through and to put a human face to it. The former Minister said, “Go and observe one of these assessments.” He is right that we should all try to do that, but I am sure he is aware of observational bias. We should not take our own observations as the only form of evidence. Up and down the country, we are hearing and seeing examples of what sick and disabled people are going through every day.

This is the first opportunity that I have had to discuss this issue with the Minister, and I want to focus on what the hon. Member for Airdrie and Shotts (Neil Gray) also focused on. We will not go away and this issue will not go away. We will continue to campaign on it, because it is a real injustice: £1,500 a year from the most vulnerable people, the poorest of the poor, some five million people—I will not continually repeat the statistics that we repeated in the two debates just two weeks ago.

What is so disappointing is that all the evidence—from the UN committees investigating human rights concerns and breaches of the convention on the rights of persons with disabilities, from our own Equality and Human Rights Commission, from the Government’s Social Security Advisory Committee, from a whole list of well-respected charities, such as Parkinson’s UK, Scope and so on, and even from the Government’s own Back Benchers—is being completely ignored. We heard about the Backbench Business Committee debate, when the motion was carried without contest, which is almost unprecedented.

The strength of feeling in this House has been expressed, yet what was so absent in the autumn statement was anything that sick or disabled people could grasp for how their lives would be made better. Their lives have been made a misery over the last six years and it will get worse. I know that the Minister is new in her post and she has said some very positive things. We have also heard very warm words from the Prime Minister, but when it comes to doing anything, the Government have put their hands in their pockets and turned away. We cannot have that. It needs to change.

The Government have put forward arguments about incentivising claimants and argued that cuts will incentivise people into work, which is quite disgraceful, really. It implies that people are making a choice. As we have heard, people are not making a choice to live on £70-odd a week when they have had a decent living before. They do not choose to do that. As the fifth richest country in the world, we have an obligation to treat people with dignity and respect. It is about choices.

I want to pick up on the point that other Members have made about what other discretionary funds people might be able to draw on. I was going through the Minister’s earlier speech last night, and the flexible support fund was mentioned. We need to understand some things about that fund. First of all, it was investigated recently for fraud. The former Secretary of State, the right hon. Member for Chingford and Woodford Green (Mr Duncan Smith), tried to claim that it was being supplemented by £15 million a year to cover the costs. That is not the case; it is actually £15 million from 2015 alone. That fund does not go anywhere near to matching the loss that people will experience and the in-year deductions that will be made as a result of these cuts.

I will finish on a point that was raised in my constituency. We all have hundreds of different cases; my case load has gone up exponentially as people have been subjected to these increased cuts. I want to talk about John Ruane, who has a brain tumour. As a consequence, he has three to four epileptic fits a week. I was contacted by his surgeon, because John was refusing to have a life-saving operation, as he had passed his work capability assessment—how could that happen to somebody with a life-threatening condition?—and he was worried that he would be sanctioned, in the same way that we saw in “I, Daniel Blake”. John had no means of support, and it has taken us months to sort this out. He has now, finally, had his ESA reinstated, but he was scared of being sanctioned because of what had happened, and the stress that he was placed under, as well as the indignity, just is not right. That is one case; I could cite loads of others.

Within the context of ESA, we cannot ignore the work capability assessment. Again, more than two years ago the Work and Pensions Committee raised the WCA as an issue in its report on ESA:

“Simply ‘rebranding’ the WCA by taking on a new provider will not solve the problems: a fundamental redesign of the ESA end-to-end process is required”.

Very briefly, I want mention another one of my constituents, a young woman who is going through the PIP process. She was a high-flyer, in a good career, and she is only in her 30s, but she is suffering from Lipedema, Dercum’s disease, fibromyalgia and chronic fatigue syndrome. She has pain in every part of her body, but particularly in her hands. She cannot even cook or prepare her own food. She has gone through the PIP process and she feels that it is just like a slap in the face. She needs that support to enable her to recover, and she feels that she is being thwarted at every turn.

This is about choices—choices about what we do. It is about whether we as a country feel that it is right to support our most vulnerable people or to support those on the top incomes—which is what the autumn statement analysis shows that we did. We on the Opposition choose that we should protect and support the most vulnerable in our society. This is about choice, and I hope that the Government will listen and do something about it.

[The Minister for Disabled People, Health and Work (Penny Mordaunt)]

I congratulate the hon. Member for Lanark and Hamilton East (Angela Crawley) on securing this debate and all hon. Members who have contributed to it.

These are important services and they are at the heart of our nation’s values and its interests. Of the 2.5 million people claiming incapacity benefits, 1.3 million also claim PIP or DLA. A further million claim PIP or DLA, but not incapacity benefits. Many of these people will also access other support and state services, as well as support provided by partner organisations.

What we do is vital, not only to enable someone to meet their living costs and endure, but to support their ambitions. We have that dual responsibility. In addition, I am very conscious, because of the combined areas that I look after, that I have the largest budget of any Minister in any Government Department. That is a huge responsibility to the general public, who fund it, and to those whom these services are designed to help. It is a responsibility that I take very seriously indeed.

PIP and ESA are entirely different benefits, designed for different purposes, and each has its own legal criteria. ESA provides support to those who face barriers to work and looks at what work a person can do, rather than focusing on what they cannot do. Unlike ESA, PIP is non-means-tested and available to disabled people regardless of their employment status. PIP provides a contribution towards the extra personal costs arising from their disability or health condition and can be paid on top of other benefits.

The PIP assessment is designed to treat all health conditions and impairments fairly, and the assessment criteria take into account the impact of all impairments, including mental health, on an individual’s ability to carry out a broad range of everyday activities. That breadth is one of the benefits of the new system in comparison with what went before, and I thank my hon. Friend the Member for North Swindon (Justin Tomlinson), who outlined some other improvements that the system makes.

The title of this debate refers to two benefits, but understandably much of the debate has focused on people, and quite rightly so, as the hon. Member for Airdrie and Shotts (Neil Gray) said. In developing our policy and delivering our services, we need to remember that it is not just about those who have been featured in today’s debate. It is also about those who have not been featured and who rarely get a mention: those who are not on benefits and are not yet in crisis, but are financially fragile; those in ill health; those with multiple caring responsibilities who do not qualify for carer’s allowance; and those who, despite hardship, do not for a variety of reasons access the benefit support available to them. Our concern and our support should stretch beyond the reach of our benefits. What we take forward from the Green Paper and all we do in the interim must have help for those people in mind.

ESA and PIP are massive systems, and both have rightly undergone, and will continue to undergo, continual improvements. Contrary to what the shadow Minister said, we have made many changes. Recent changes include the announcement that we will stop ESA reassessments for those with severe health conditions and disabilities. In designing the changes, I have asked that we plan ahead and see whether we could have permission to share information with local government. That could enable local authorities to stop requiring those very same people to fill in forms for locally administered schemes. In his speech, the hon. Member for Strangford (Jim Shannon) outlined some of the potential benefits of doing that when he mentioned social care and other services.

With ESA, we now have clinical data to hold contractors to account. I pay tribute to the DWP’s chief medical officer and her team for the work they have done on that and on data sharing. We have trialled greater flexibility on the time given to the early stages of an application process to ensure that all the health information is available to the assessor. That is the best way to cut down on incorrect decisions being made at that early stage.

[Debbie Abrahams]

Will the Minister give way?

[Penny Mordaunt]

If the shadow Minister will forgive me, I will make some progress.

We are rolling out that trial. The past presence test will no longer apply to claims for DLA, PIP, attendance allowance and carer’s allowance with regard to refugees, people with humanitarian protection status and their families. We are extending hardship payments. The ESA appeals process has been reformed, with mandatory reconsideration clearance times down from 35 days to nine. The number of weeks and the percentage of case load having to go to appeal to get the right decision are both reducing. Huge strides have been made in identifying hidden impairments, including through training of staff.

The hon. Member for Lanark and Hamilton East spoke at length about the factors of appearance. Many people might look perfectly together and presentable but have deeply hidden issues. We have done a huge amount in training staff to recognise that, and more is planned. The Secretary of State has announced his focus on the use of sanctions with those with mental health conditions, and the Green Paper gives us the possibility of major reform to different parts of the system in unison. In that consultation, we want to examine how we might simplify and improve the assessment process and how we can use information better to effectively support people, such as sharing data—with claimant consent—with support organisations and other state services. The reform of the work capability assessment—which we have not been able to do to date because it requires primary legislation—is a focus of the Green Paper. We could separate out decisions on entitlement to employment support and entitlement to financial support.