Mental Health: Assessment

Debbie Abrahams Excerpts

Tuesday 22nd January 2019 Westminster Hall

[Angela Crawley]

That would be absolutely fine if the assessor had that level of medical qualification and experience. The point is that they do not. It is fine for a doctor to say that they would ask those questions, and of course any doctor reasonably would, but that is not how this has been delivered. It has not been asked by a trusted medical professional such as a doctor, psychologist, psychiatrist or other professional with the correct experience and understanding of how to handle the situation, the follow-up aftercare or anything that comes with it. The assessor is an individual sitting with a form; it is not the same experience, so I appreciate the hon. Gentleman’s point, but that is just not how it works in reality.

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

The hon. Lady is making a very powerful speech. Are not DLA and its successor, PIP, meant to be about supporting disabled people with the extra costs that they face, which are about £560 a month? This system fails to recognise the real injustice that disabled people are experiencing, and unfortunately the Government are just not addressing that.

[Angela Crawley]

I completely agree. The point is that mental illness is a disability—that is what we have argued in previous debates—and should be recognised as such and handled appropriately. I am grateful for the point made by the hon. Member for Central Suffolk and North Ipswich, but we are not having this debate because there is an issue with the healthcare system; I am arguing that there is an issue with the practitioners in the Department for Work and Pensions.

The question to which I have referred has been asked without any follow-up, without any understanding and without the qualification and experience to handle it appropriately. I just cannot understand how it is appropriate or why it is necessary for the assessor to ask that. The ultimate fact is that it can be devastating for people with suicidal depression to have to justify such a dark thought; it can shake the foundations of their wellbeing and make them question their worth. It is not uncommon to hear from people that their personal independence payment or work capability assessments have made them feel worthless. It is not uncommon to hear that from my constituents; indeed, it is all too regular. That is why I am raising this matter with the Minister.

Since 2011, assessors are meant to have had, as part of the assessment process, access to a mental function champion or mental health champion for support and training. I am not sure whether that is working in practice, which is why I urge the Minister to look at it. In not one of the cases that I have dealt with regarding mental health problems has a mental function champion been used. That prompts the question: if the training and capacity are there, why is that not being used by the local DWP jobcentre staff? Why is it not being used to assess people appropriately? Why are assessors not using the support that is available to them if it is in fact there, provided by the Department for Work and Pensions?

I have made challenges in a number of cases in which some support for the assessor on mental health issues would have been appropriate, yet such an intervention has never been used. I have had trouble trying to find concrete figures for how many mental function champions there are across the service and what their role is. I would be grateful if the Minister could enlighten us on exactly what the mental function champions are supposed to do, what role they are supposed to play in the assessments, and how their effectiveness is being measured, because ultimately I was unable to get relevant or accurate statistics from the Department outlining how well that function is being used. If it is there and not being used, it seems that assessors are doing a disservice to the individuals who come face to face with them every day.

When someone is found fit for work but in fact is not, they need to go through the arduous process of appeals. For people with a depressive or other mental illness, that process is extremely difficult and can exacerbate their symptoms. For some, the process is too daunting and they will simply go without the support that they need. I can only imagine the number, because we will not have accurate statistics for how many people go without as they are unwilling to go through that process. I do not believe that that is the right approach to mental illness—or to public expenditure; it would save the Government time and money if assessments were correct, and the correct benefits were awarded at the first stage, in the first instance. The fact that people are having to go through the appeals process and decisions are being overturned at the mandatory reconsideration stage tells us that there is something wrong with the system that could be fixed.

Not only is this a waste of resources for the Department for Work and Pensions and our courts system, but it depletes the mental resources of people who do not have the energy to spare to go through the process. I believe that, ultimately, discrimination against mentally ill people is built into the whole culture of this system. If people disagree with that, they can just ask the High Court. The Government were found in 2018 to have discriminated against mentally ill people in the High Court ruling on regulations that meant that people who were unable to travel for reasons of psychological distress were debarred from the enhanced rate of the mobility component of personal independence payment.

I do not even know where to start with that. If someone has identified under the previous, legacy system that they are unable to travel or have limitations, and then that is undermined in the new system, that seems counter-intuitive. There is surely a better way of operating. The transition from DLA to personal independence payment has been anything but smooth; in fact, there are still flaws and errors in the system. That is all that I am trying to get to here. I really want the system to work better for people, because ultimately I would rather not have to deal with individuals having this horrible experience every day. They should not have to come to me to get things improved; the system should just work better.

The regulation to which I referred was introduced in March 2017 without any stakeholder consultation. I urge the Minister to reconsider that. There are mental health charities and experts outside the House who would be able to provide the relevant and necessary information to the Minister, if she were willing to hear it. That civic engagement would get things correct for those who have used the service and had an adverse experience; it could only enhance and improve the experience.

The High Court ruling represents just a small part of the benefits system, but I think that it represents well the Government’s approach to people with mental health problems. The personal independence payment system, contrary to the Government rhetoric, was designed so that fewer people would be eligible for it than were for the legacy benefit of DLA. If the entire concept and design of a system is to get more people out of the system, it is not really doing what it was designed for, which was to help people. It just seems ridiculous that we are working to these arbitrary targets; that is the only way I can understand this. If we are trying to reduce the number of people on the benefit, even if there is no reduction in the number of people who need the support, ultimately we are just letting people fall through the net. That is a dereliction of our duty of care to the people we serve.

One quarter of people claiming DLA for mental health conditions do not qualify for PIP when reassessed, so they lose the support that they need.

--- Later in debate ---

[Peter Grant]

My view is that the fundamental flaw was built into the system from day one, when the entire review started from the bottom line of financial saving and everything else was built on top of that. A benefits system cannot be built on a price tag, especially a price tag significantly lower than the current cost of the benefits system. That will guarantee that a significant number of people will be left a lot worse off than they were. A system has never been invented that ensures that the tiny minority of people who play the system are called to account and those who need to benefit are protected. Far too often, the system hits the easy targets rather than the ones who should be stopped from abusing the system.

What are the assessments for people with mental health problems in the benefits system supposed to do? They are supposed to give additional support to anyone living with a disability that makes it dearer for them to have the basic essentials of life. They are supposed to provide financial support for people who cannot get into work and help those who will be able to get into work to get there. We must recognise that some people will never be able to carry out enough work to support themselves financially. For those facing that reality, the system is supposed to help.

Instead, our system makes the situation worse for somebody with mental health problems that prevent them from working. We are talking about things that on their own might not seem that severe, such as anxiety, which can be made worse if they keep getting knocked back or psychologically beaten about. These people struggle just to carry on the usual social contact that some of us take for granted and lack the simple social skills that are essential to survive in the workplace.

For people struggling with those problems due to mental illness, which can be exacerbated by the way they are being treated, the worst thing we can do is force them through a system that makes them feel even less worthwhile than before they went in, even worse about themselves and even more anxious about their next assessment.

We would not assess a blind person with a paper form and we would not assess a deaf person over the phone, unless there was somebody at the other end to interpret for them. Why should it be any different when assessing somebody whose difficulties are related to severe anxiety and the inability to cope with going out the door and taking a bus on their own? They are told to go to an address they have never heard of, in a place they have never been to, to find their way there by a bus that they do not know exists, by a time set by the assessors, and to pay their own way there. By the time they get there, if they are lucky, an assessor will carry out the interview, but if the assessor does not turn up, that is okay. However, if the claimant does not turn up, they get their benefit stopped. Then we wonder why people think the system is rigged against them.

The whole work capability assessment is lengthy and demeaning. It treats people as numbers—as statistics. Sometimes it treats people as problems, instead of as human beings who need the support of a caring and civilised society. For example, most of my constituents are quite surprised, if not astonished, when they discover that it is not routine for the DWP to ask for a report from their GP or community psychiatric nurse, if they have been getting support from a nurse. They will sometimes ask for it, if the claimant themselves insists on them asking for it, but why do they not do it routinely? Surely the person’s own GP and the health professionals—those with qualifications in psychology or psychiatry—who have worked with this person, sometimes for years, have something important to say about their ability to work now and the realistic prospects of them getting back into work in the future.

Tomorrow, it will be exactly a year since I asked an urgent question in the Chamber about changes to personal independence payment assessment criteria. That followed a Government defeat in a case in the High Court where, in essence, the Court ruled that the assessment process the Government had put in place was illegal, because it discriminated between people with mental health problems and people with physical disabilities. On 23 November last year we received an update on that case: 140,000 cases had had to be reviewed and £4.5 million in benefits had been paid back to 1,000 people. I know that the succession of Ministers we have had in the DWP like to quote statistics about the percentage of people who like the result and the percentage of people who do not. In that case, 1,000 people were owed the money, which they needed just to have a decent standard of life. This Government had unlawfully withheld that money from them. We still do not know how many more people are due to get money back once the full review has been carried out. These are not the actions of a caring society.

Some of my constituents have turned up at assessments that were difficult and stressful to get to and found that the assessment had been cancelled. They had paid the cost of getting there, sometimes borrowing money to pay the bus fare, and the assessment was cancelled. At other times they have turned up and the paperwork had been lost or the person who had read the paperwork had phoned in sick. A different assessor had no idea who the person coming in to be assessed was. It is no wonder it creates the impression that, “The system really does not care about me. It does not see me as a human being. It sees me as a problem instead of as a human being with intrinsic value and the same rights to be treated properly as anyone else in our society.”

[Debbie Abrahams]

The hon. Gentleman is making a powerful speech. Is he as concerned as I am about the York University report that came out today, which states that people with mental health conditions are two and a half to three and a half times more likely to have their PIP claim reduced or stopped than people with physical health conditions? Does he share the view of the Royal College of Psychiatrists that if there is parity of esteem for mental health and physical health conditions in the health service, there should also be parity of esteem in social security?

[Peter Grant]

I am grateful for the hon. Lady’s comments. I have not seen the report, but my impression has been that people with significant mental health problems do not always help themselves and act in their own best interest. As a society, we have not got a balance about how far we allow someone to be who they want to be and live their own life. At what point do we step in and say, “You are not doing yourself any favours”? I have met far too many people whose initial problem started with a letter saying they had to go for an assessment, but, because they were scared of an assessment, they did not go, and from then on the problems multiplied.

I had one recent case of a constituent whose behaviour admittedly sometimes was completely unacceptable. One of the ways that he responds to the fact that he cannot cope is by getting aggressive. In at least one instance, he caused damage in a DWP office. I cannot condone that, but it turned out that one of the things he was annoyed about was the fact that his benefit had been substantially reduced. He did not think he had seen a letter telling him why it had been reduced, and we could not find anything, either. It turned out the DWP had decided that because he might react badly to being told that, it cut his benefit, but decided not to tell him what it had done. So that information was kept in a part of the system that assessors could see, but he could not. The assessor was supposed to try to help him get back into the workplace. The DWP thinks he is capable of doing some work, so it thinks he is capable of all the stresses and strains and upsets that go with going out to work in the morning, or in the afternoon, but he cannot be trusted with information about his own claim in case he reacts to it in the wrong way.

I do not think anybody here would like to sit down and design the perfect benefits system from scratch. I do not suggest that I have all the answers, and there will always be difficult judgments to be made. There will always be cases when someone has to decide, “Is this somebody who knows how to work the system and is chancing it, or is this somebody who really needs help?” I would much rather the system was biased a little more towards accepting that a tiny minority of people can play the system in order to make sure that nobody who needs the support of the system is left behind, but the experience of my constituents is that it is very much loaded in the opposite direction. In numerous cases that I have raised with various Secretaries of State for Work and Pensions—more than six since I was elected—after a few months, the answer has come back that the person has abandoned their appeal and is not going through with the latest stage in the process. Some in the DWP see it as a success every time someone does not carry through an appeal, because that means they have accepted the result. They do not think it means they have given up because they simply cannot win against a system that they feel, and sometimes I feel, is designed to stop people getting what they are entitled to get.

If we look at what has been happening since some of the benefits system was devolved to the Scottish Government, they were criticised for not moving quicker, but the first thing they did was to embark on a major consultation and engagement process not only with the usual suspects, but with people who had been through previous processes. They went out and actively looked for people who had either got successful claims or had lost out under the previous system to find out from them what they thought the system should be like.

The Scottish Government have given an assurance that any benefits assessments they are responsible for will not be carried out by private companies, so any suspicion that there is something in it for the private assessor who says no instead of yes is immediately taken out. The DWP will always say that that is not the case, but if a private company hopes to get the contract in a few years’ time, there will always be that suspicion, especially in the minds of those who do not get the result that they want.

We need to go back to the basics of what people are entitled to get either from the benefits system or from any other part of the state. The Scottish Government have said from day one that their system will be based on fairness, dignity and respect. Every one of our citizens deserves that, whether they are dealing with a benefits application to the DWP or in any other interaction with the Government. At the moment, far too many of my constituents do not feel they are being treated fairly. They do not feel they are being respected as human beings and they definitely do not feel that they come out of the process with the dignity that each and every one of us is entitled to. Until that changes, I cannot support the system. I want to see it fundamentally changed or scrapped altogether so that we go back and start again.

--- Later in debate ---

[The Minister for Disabled People, Health and Work (Sarah Newton)]

It is a pleasure to serve under your chairmanship, Ms Ryan.

I begin by my adding my praise to that of other Members for the hon. Member for Lanark and Hamilton East (Angela Crawley), both for securing this debate and for the way in which she addressed the House. She and others are absolutely right: I am utterly determined to make sure that we improve the system by which we assess people for employment and support allowance, the personal independence payment and of course universal credit. I am just as ambitious as everybody else in the room to ensure that we treat everyone in society with respect and dignity, and really promote their human rights.

On independent assessments, people who go on this journey—I do not want to call them claimants or customers; that was a good point well made by the hon. Lady—through the system give the approach that we have taken to both ESA and PIP a satisfaction rating in the high 80s. That is the vast majority of people applying for these benefits. This is not something we measure internally; it is properly independent research that we publish and is open to scrutiny. One poor experience is one too many. We are utterly determined to improve the experience at every stage of the journey, and really put the person at the centre.

PIP was introduced to ensure that mental and physical health conditions have parity of esteem. Many more people are benefiting from it than ever did from disability living allowance, and are getting the higher rates of support, for both their daily living and their mobility. Broadly, therefore, it is working, but as we have heard, there are some absolutely horrendous and terrible cases of unacceptable behaviour, where things are going wrong. I thank all hon. Members who have come along today. It is clear that everyone here wants to do the best they can for their people and to work with me to absolutely get this right, and I welcome that.

I want to answer questions, but I have been given very little time to respond; that is the nature of these debates. As always, I will write to hon. Members on any questions that I do not have time to address. I start with the invaluable work of the Work and Pensions Committee. It is great to have one of its members here speaking up for that. The Committee gathered a huge amount of evidence, and I looked through all the research findings and the Committee’s recommendations thoroughly. We have agreed to implement all those recommendations, and we are carefully working our way through every single one of them. I want to reassure hon. Members that I work very closely with SSAC. It is an invaluable body. Everyone in the Department always thoroughly considers its reports and recommendations, and whenever possible we seek to implement them.

A few hon. Members mentioned video recording, which, when I came from the Home Office to take up this position, I thought was a really good idea. One of the fundamental problems we face with people claiming benefits is a lack of trust. Unfortunately, too many people are worried. We have today heard eloquent contributions about people being really worried about having to go through the process. In spite of the fact that most people have a really good experience, most of them are worried before they enter the process. I obviously want to eliminate that, as does everyone in the Department.

I want people to fill in the forms confidently, and pick up the phone or go into their jobcentre thinking, “There will be compassionate people who will help me”. That is what we are all striving to achieve. I believe that video recording the assessments will play an incredibly important role in regaining people’s trust in the whole process. Hon. Members will know that audio recordings are already available, but they are not done with the most up-to-date equipment. It can be a clunky and difficult experience, and I want to make it as easy as possible.

Throughout the summer we did a lot of work both with people who are claiming benefits and with healthcare professionals. All assessments are undertaken by fully qualified healthcare professionals. They are mostly nurses, but they all have experience and they have additional training in how to undertake the functional assessments. They are highly motivated and trained individuals, and it was important to consider how they felt about the video recording, just as much as how people coming in to be assessed felt about it. Having taken all that into consideration, we have started a pilot, which is going well. It is voluntary, because we wanted to ensure that people felt really confident about having their assessments videoed.

The strength of the pilot will be that lots of people take up the opportunity. There is no point coming up with a videoing possibility if people are not prepared to say, “Yes, I would like my assessment to be videoed”. We have been working carefully on the pilot and will review the findings to see how and when we can roll the initiative out. There is an absolute determination and commitment to doing that, because it will build the trust and confidence in the system that we want.

We have also been looking at every single stage of the process. I really want to assure hon. Members that I regularly meet our stakeholders—the large charities and disability rights organisations. We have a PIP forum and a stakeholder team working with us on improvements to the work capability assessment, and disabled people are really getting alongside us and working with us on improving the process. I have already commissioned an independent review of the PIP application process. We have been looking carefully and in detail at every single part of the claimant journey—the person’s journey—through the system to see what more we can do, right through to how we can improve our mandatory reconsideration process. At the same time, as I said, we have been implementing the very helpful findings of the Work and Pensions Committee.

Going back to comments about what happens in the assessment, we will make a decision based just on the application, without sending someone to a face-to-face assessment, if we can gather enough information from the person applying for the benefit, and if they provide information from healthcare professionals, whether they be consultants, GPs or community mental health nurses. We will use that information whenever possible. A lot of our work over the summer was engaging with healthcare professionals to try to understand the barriers to their providing us with information. Relatively small numbers of people go to appeal, and relatively small numbers have decisions overturned. Most often, decisions are overturned because more information has become available by the time of the appeal. I am determined to see what we can do to have the information provided up front by healthcare professionals, so that we can make more paper-based assessments, without the need for face-to-face ones.

Hon. Members will know that we have introduced a set of new criteria called the severe conditions criteria, for employment and support allowance and now for PIP. If people have severe mental or physical health conditions that, sadly, are not going to improve, we put them into a category where they do not have to be reassessed, apart from a very light-touch reassessment after 10 years, just to ensure that their circumstances have not changed. That means that fewer people will be reassessed, and I hope that everyone here can commend that.

On some of the other observations on face-to-face assessments, we have had quite a discussion about the mental health questions. The questions that the assessors use and the training they receive is all approved by the National Institute for Health and Care Excellence. I think hon. Members were referring to the mental state examination questions. As my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who has left the room and is a doctor, said, this is the best practice of the medical profession. It is really important that the Department takes its duty of care very seriously—and we do. Right through from our job coaches in Jobcentres Plus to people in our telephony services, we have a really good process to ensure that anyone expressing suicidal thoughts is supported. For example, everyone in our jobcentres is going through mental health training to ensure that they feel able to chat to someone with suicidal ideation and keep them safe and in front of them while their colleagues secure additional support from the NHS. We take that extremely seriously and are led by the best evidence—

[Debbie Abrahams]

Will the Minister give way?

[Sarah Newton]

I have so few minutes and so many questions to answer.

I want to reassure hon. Members that our work in this area is led by the best possible clinical input. The deputy chief medical officer, Professor Doctor Gina Radford, oversees all this work, because keeping people safe is just as important as treating everyone with respect and dignity and ensuring that their human rights are upheld.

I will conclude, so that I can give the hon. Member for Lanark and Hamilton East a few moments to wind up. I am absolutely determined to carry on our work on fibromyalgia and on all the issues she has mentioned. I have invited people into the Department for weekly meetings, so that together we can make the changes we want to see.