Employment and Support Allowance Application

Eilidh Whiteford Excerpts

Wednesday 7th May 2014 Westminster Hall

[Dr Eilidh Whiteford (Banff and Buchan) (SNP)]

It is a pleasure to serve under your chairmanship in this short debate on the employment and support allowance application process for those with mental health problems, Mrs Main. We may be a small, select company this afternoon, but I am sure that I am not the only MP to have seen over the past couple of years a steady and increasing stream of people with quite serious mental illnesses falling through our social safety net, which is now very frayed because of welfare reforms. Despite modifications, the work capability assessment is still failing too many people.

It goes without saying that most people with a mental illness will never need to depend on the benefits system, but some of those with more severe or persistent illnesses do require support, and some of them are extremely vulnerable. In the time we have for this debate, I want to focus on the shortcomings of work capability assessments with regard to mental health conditions and make some concrete suggestions about how the process might be improved.

The issue is by no means new. Ever since the introduction of the work capability assessment, mental health care professionals and representative organisations have expressed concerns that it does not capture the impact of more serious mental illnesses on a person’s capacity to function in a working environment and consequently leads to poor decision making. A core problem is that too often assessors and decision makers have little or no relevant background information about claimants’ complex medical histories and too rarely seek input or opinions from claimants’ clinicians.

The problems were clearly acknowledged at the time of the first Harrington review, when Professor Harrington said that decision makers should be

“able to seek appropriate chosen healthcare professional advice”.

In his third review, he recommended that they

“should actively consider the need to seek further documentary evidence in every claimant’s case”.

The fourth review, led by Paul Litchfield, devoted significant attention to the assessment of mental function and made a number of recommendations, some of which the Government have accepted. However, the Royal College of Psychiatrists said this week that

“there is little evidence of any significant increase in the collection of evidence by either ATOS HCPs or DWP Decision Makers.”

The issue is not going away; indeed, it is being compounded by the new Department for Work and Pensions sanctions regime, which is having an acute effect on people with mental health conditions. According to a freedom of information request, in 2013, 58%—almost six out of 10—ESA claimants sanctioned were people with a mental health condition or learning difficulty. That is an increase from 35% of sanctioned claimants in 2009, and it suggests that people with mental health problems are being inappropriately sanctioned.

There is a growing body of evidence from a range of sources that, in spite of the changes that have been implemented along the way, the work capability assessment is still failing people with serious mental health problems. However, I want to highlight the report published recently by the Scottish Association for Mental Health, or SAMH, which details findings on how experiences of living in poverty affect peoples’ mental health, and how SAMH service users have been affected by welfare reforms.

SAMH has been a leading mental health charity in Scotland for many decades and works directly with thousands of people across the country, helping them to recover from mental illness and offering support and training. It also works to improve policy and practice in relation to mental health, reduce stigma, raise awareness and promote well-being. SAMH undertook a major survey of its service users in 2013. The truly shocking finding was that 98% of respondents said that welfare reforms were negatively affecting their mental health, including increasing stress and anxiety, while 79% were also facing financial problems. Of SAMH staff, 85% said that they were having to provide additional support to service users as a direct result of the welfare reforms, and, in six cases, SAMH staff had to carry out suicide interventions directly related to welfare reforms.

I know that the Minister will be well aware of the tragic case of a woman known as Ms DE, whose suicide in 2011 was the subject of an investigation by the Mental Welfare Commission for Scotland. Ms DE took her own life after scoring zero points in a work capability assessment made in the absence of an ESA50 form and without any additional information from her clinicians. The only information her assessor had about her condition was the single word “depression”, a word that in her case masked a long and difficult psychiatric history. Both her general practitioner and consultant psychiatrist considered Ms DE unfit for work at the time of her death, even though she had worked for most of her adult life. Indeed, the significant event review after her death noted that

“Ms DE was hoping to return to employment at some point.”

However, it also noted the distress caused by her benefits assessment and the role that it may have played in her suicide, concluding that there was “no other known trigger”.

[Jim Shannon (Strangford) (DUP)]

I am grateful to the hon. Lady for giving way, and for her permission to make an intervention. Just this week my office has dealt with two ESA appeals and four inquiries on the subject. Each one of those six cases relates to addiction or mental health problems. I am very aware of the far-reaching impact that the process has on people, which the hon. Lady outlined. Does she agree—she probably will—that if there is no compassion and understanding in the system, as there seems not to be, many other people will come to the same point as the lady whose case she is describing?

[Dr Whiteford]

I think that is right. On reading the evidence produced by organisations that support people with mental health problems, it is very clear that the increased anxiety and stress can contribute to ill health and make people more ill than they were to start with.

The report makes upsetting reading, and we should all express condolences to the unnamed woman’s family. Her death is a sobering reminder to all of us of the very real impact that Government decisions and state bureaucracies have on people’s lives. However, I was also struck by the very robust terms in which the Mental Welfare Commission, a statutory body, questioned the effectiveness and appropriateness of the work capability assessment and how it was working. As part of its investigation, the Mental Welfare Commission conducted a survey of responsible medical officers working in health boards across Scotland, most of whom are consultant psychiatrists, and 80% of respondents had patients who had undergone work capability assessments. Of those 80%, most had been asked to provide medical evidence, either before or after the assessments. However, three quarters had never been asked for their opinion at any point in the Atos or DWP process. Only 25% had had a request—some before the assessment, some after—and 96% said that their patients had been distressed by the assessment process; 93% reported patients distressed at the outcome of an assessment; and 80% reported patients who had successfully appealed decisions.

What also gave me great cause for concern was the impact on clinical care provision: 85% of the RMOs reported an increased frequency of appointments; 65% had had at least one patient who required an increased dose of medication; 35% had at least one patient who had been admitted to hospital as a consequence of a work capability assessment; 40% had at least one patient who had self-harmed after the assessment; 13% reported that a patient had attempted suicide; and two psychiatrists reported patients actually taking their own lives. In the light of the anecdotal evidence from the hon. Member for Strangford (Jim Shannon), I can say that various sources show that this is not just hearsay; evidence is coming from reliable and credible people who are involved in the process, and who understand that the systems are having real and difficult consequences for people.

It is critical that greater use of expertise is drawn into the assessment process for claimants with mental health conditions. I acknowledge the conclusions of the Litchfield review on this point, which were that it may not be necessary in every case, but there seems to be an enormous gulf between a universal approach and current practice. It is a chasm into which large numbers of very ill and vulnerable people seem to be falling. SAMH found that 56% of its service users did not receive any supporting information from a health care professional in their ESA application, which, in the wake of the tragedies we have heard about, should shake us out of any sense of complacency that we are doing enough.

The DWP’s most recent quarterly statistical bulletin, published in March, outlined the total caseload to date. With regard to completed claims, 52% of people who made new applications for ESA on the grounds of mental or behavioural disorders were found fit for work, so the high numbers of people awarded ESA on grounds of mental ill health represent less than half of applications made because of these conditions. Too many people are falling through cracks in the assessment process. I have alluded to the increased pressure that this creates in the NHS, but it also brings attendant costs in social care, policing and homelessness, which outstrip the cost savings that the DWP might be making.

Throughout the work of the Harrington and Litchfield reviews, there is an implicit acknowledgment that the work capability assessment is not working as it should and not working well enough for people with mental health problems. My request to the Minister today is simple: will he meet me and representatives of SAMH to discuss some of the ways in which the recommended improvements might be integrated into the work capability assessment?

I know some changes have been instigated since 2010, and I note Professor Harrington’s evidence-based review of December 2013, which considered whether a more specialised test developed with disability organisations might be more effective. Although that test was found to be less effective than the work capability assessment in determining fitness for work, it proved more effective in determining limited capability for work. Lessons could be learned from the scoring approach used in each assessment, so I want to ask the Minister whether he can provide an update on how the Government are using those insights to improve the work capability assessment.

It was announced in March that Atos Healthcare will leave its contract early, with new contractors commencing in 2015. The renegotiation of the contract presents an ideal opportunity for the DWP to reconsider how the right information and expert opinions can be brought into the assessment and decision-making processes. SAMH is of the view that claimants should be asked at the beginning of their application to nominate relevant health care professionals to provide supporting statements. That would significantly reduce the stress on individuals, improve input from professionals, and, we have to conclude, lead to better decisions the first time round, reducing the need for costly and stressful appeals. With the DWP in the process of reviewing and updating its contract, surely this is a prime opportunity—the ideal moment—to introduce a process by which the statements could be secured. What practical steps might the Minister take to move this forward?

Lastly, the SAMH report highlights the increased stress and anxiety for claimants who face lengthy waits for assessments, often have to live on a reduced income, and fear that they will not get a fair assessment. That has come out in the past few years as people see what happens to those in their support groups and social networks, who have come through the system and feel that the assessment concentrated on their physical health, not their mental health. Sometimes their physical symptoms can be connected to their mental health problems, but they are often more easy to cope with in day-to-day life than the debilitating effects of mental illness.

The reduction in support services as a result of austerity cuts has left some very unwell people unsupported. The DWP could minimise such distress by providing clear, accessible information to applicants at the outset of the process, signposting them to organisations that can provide advice on welfare rights, finances and well-being, and setting out the process by which health care professionals can be contacted regarding supporting statements.

[Jim Shannon]

Problems have come to my attention relating to correspondence with those who have mental health issues. Often, correspondence is mislaid or inappropriately addressed, which means that people with mental health issues are not aware of the process and how they should respond to it. The Minister always responds positively to the issues, but does the hon. Lady feel that one of the things that could be done better, when dealing with people with addiction and mental health issues, is ensuring a follow-up whenever responses are not made directly to the Department?

[Dr Whiteford]

The hon. Gentleman makes a very important point. Indeed, that was one of the key recommendations of the report by the Mental Welfare Commission for Scotland in the case of Ms DE. Attempts had been made to contact her, but there were no repeat attempts and no one managed to get hold of her. It is easy to envisage somebody who is suffering from severe depression not answering the phone and not opening the mail in the way that someone in a healthier situation was more able and minded to. Those points have been well made, and I am sure that the Minister is already cognisant of them, but I will be interested in his response on the process, particularly in the DWP, going forward.

Relatively small steps could have a marked impact on people’s lives, and could help ensure that the process does not actively contribute to people’s mental health problems, but helps set them on the road to recovery. Will the Minister consider what he can do in terms of signposting, explaining to people their rights in the process, and making sure that we are not making things worse for people who are already very ill? It is in everyone’s interests to achieve a work capability assessment that is fit for purpose. I hope that the Minister will take the time to read the SAMH report and hear the perspectives of those with most at stake in the process and who badly need our support, and I hope he will meet us in the not-too-distant future.