Austerity: Life Expectancy

Debate between Jim Cunningham and Louise Haigh

Wednesday 18th April 2018 Westminster Hall

[Louise Haigh]

I could not agree more with my hon. Friend. She makes an important point, because it is exactly those post-industrial towns and regions that were invested in so heavily under the last Labour Government and have seen a fall in life expectancy over the last seven years.

Regional and class inequalities in health, as we know, are nothing new, but there is a more distinct change now taking place. In my city of Sheffield, the healthy life expectancy for women of 57.5 years has dropped by four years since 2009, while healthy life expectancy across the country has basically held steady. There are already too many areas in our country where healthy life expectancy is unacceptably low. The average baby girl born in Manchester between 2014 and 2016 will live to be 79, but only until age 54 will she be healthy. That is almost one third of her life spent grappling with health issues that will not affect the average woman born on Orkney until she is 71 years old.

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

One of the factors, if not the sole factor, is that when we look at the past recession, most of the burden has been inflicted on women generally. We all know that. That is an anxiety factor, and there are good examples of it. One good example is the women of the Women Against State Pension Inequality Campaign. A lot of them were due to retire and had plans; those plans have gone now, because they will not get their entitlement. There are a number of factors that affect women more than men, particularly during a recession.

[Louise Haigh]

My hon. Friend is absolutely right. It has particularly hit older women, and I will come on to that disproportionate impact shortly.

Something is adversely affecting the health of our population, and as my hon. Friend has just said, none of it is happening in a vacuum. The observation is unavoidable that these patterns coincide with the era of austerity. It is simply inconceivable that the state of our public realm, welfare system, housing, fuel poverty, child poverty and our NHS have nothing at all to do with it. The number of NHS trusts with budget deficits has increased sharply since 2015, as have waiting periods for elective surgery and waits for urgent care. Hospitals are now warning of an “eternal winter”, as records show the number of patients receiving urgent care within four hours fell to a record low in March 2018. Almost half a million patients waited longer than 18 weeks for planned care.

This week, the Royal College of Physicians raised the alarm, writing to hon. Members to tell us that hospitals are “underfunded, underdoctored, overstretched”. That will not be news to anybody who has been anywhere close to the NHS in recent years. However, the shortage of doctors and consultants revealed by the RCP is systematic and shocking; 43% of advertised consultant posts last year in Yorkshire and the Humber were not appointed to. In acute medicine, only five out of 26 posts were successfully appointed to. The RCP concludes that these workforce shortages have direct implications for patient safety. Although our hospitals still provide expert care, relentlessly drawing on the good will of staff—who cannot possibly provide the best possible care when under such pressure—is unsustainable.

Issues within the NHS are being compounded by problems with the provision of adult social care. According to the King’s Fund, in 2016-17 there were 380,000 cases of a delayed transfer of care due to patients’ awaiting a hospital assessment. A similar number were waiting for a place in a nursing home. It is little surprise that the sorry state of our social care system should be linked to a fall in the life expectancy of older women living in the poorest parts of the UK, because that cohort has seen a disproportionate fall in their life expectancy. For the first time, health inequality is rising because the most deprived are suffering with poorer health.

I have often heard it said that the elderly have been protected from the worst ravages of austerity, but the elderly who live in deprived communities have been hit many times over. Relevant to this debate, they have been hit first by the cut in pension credit for lower-income groups and then through the funding pressures on adult social care. Of course, it is in the local authorities serving the most deprived areas that these effects have been felt the most.

Work Capability Assessments

Debate between Jim Cunningham and Louise Haigh

Tuesday 9th February 2016 Westminster Hall

[Louise Haigh]

I could not agree more, and I will come on to that issue.

This is about providing not just a good-quality service for clients, but best value for money for the taxpayer. As I said, when one side is trying to cut costs and another is employed to maximise profit, something has to give. As report after report has identified, the contractors that the Government have employed to carry out cuts have been anything but successful. They have presided over failure after failure. There has been poor performance, a disregard for vulnerable people and, in this new age of outsourcing, a total lack of accountability for Government and operator alike.

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

I congratulate my hon. Friend on securing this timely debate. The cost to the taxpayer is some £80 million this year, up by £24 million on last year. Does she agree that these private companies are taking the taxpayer for a ride?

[Louise Haigh]

Again, I completely agree with my hon. Friend, and I thank him for that intervention. The contractors continue to get paid despite repeated failures. Even worse, after being deemed unfit to perform in relation to one contract, contractors simply get to continue with another lucrative long-term deal, as Atos has done. After failing to handle the work capability assessments contract, it is still running a seven-year contract for personal independence payment assessments for the same Department. Now Maximus is failing to meet a range of key targets—targets that, importantly, put far greater emphasis on saving money than on meeting the needs of people who unjustifiably suffer. Whatever the rhetoric about service quality, this is still a system designed to cut costs for the Government and maximise profit for Maximus.

We have undoubtedly all read last month’s report by the National Audit Office, but some of the figures deserve to be rehearsed. Despite the new contract—which followed Atos’s spectacular failure—being worth some £570 million a year, there is still a backlog of 280,000 employment and support allowance claims. The average cost of each individual assessment is now almost £200, and that is for a 15-minute assessment. One in 10 disability benefit claimants’ reports are rejected as below standard by the Government, compared with one in 25 when the shamed Atos was running the show.

Individuals have to wait an average of 23 weeks for a decision to be made on their benefits; there has been a huge rise in that timescale—almost a trebling—in recent years. For each person, that can and almost always does mean hardship, but the number being referred keeps rocketing as the Government, desperate to clear the books at any cost, lay the bill for clearing the deficit squarely at the door of the sick and disabled. The Government are forcing away from ESA people who need and rely on it, and the failing contractors are being overwhelmed. Despite all that undeniable pain, unbelievably, the Department is not expected to meet the initial £5.4 billion savings target originally envisaged for the 10 years to 2019-20.

--- Later in debate ---

[Louise Haigh]

Of course, I completely agree. The Government’s policy sets the direction for the contractors, which is why the contractors have such a huge gap in their understanding, particularly of mental health issues.

In another case, one of my constituents applied for a home visit after being unable to make their assessment. She has now been waiting for more than two years and still has not received a date. Throughout that time, she has been surviving on a reduced rate and is struggling, as anyone would, to get by. She is just one of 280,000 people in an enormous backlog.

Despite the fact that the Government have made it notably harder for people to appeal their decisions, as my hon. Friend the Member for Bermondsey and Old Southwark (Neil Coyle) mentioned, the latest figures show that 54% of appeals result in decisions being overturned. As in the case of the first constituent I mentioned, there seems to be an alarming trend of cases being rejected based on factual errors or even—I hesitate to say this—falsification. I have had several cases of people telling me that their assessment report bears absolutely no relation to the assessment that they experienced with Maximus or Atos. I am sure that other hon. Members have heard similar evidence. One or two cases could be dismissed as an honest mistake, but the situation appears to reveal a disconcerting pattern of behaviour that indicates that the trade-off between cost cutting and profit maximisation is being felt by very vulnerable people.

Maximus is not doing this to make a loss or out of the kindness of its heart, and it is failing on performance, which goes to the heart of the issue. Even if the Government were more concerned with the interests and wellbeing of the user, it would be extremely difficult for them to hold the contractors’ feet to the fire.

[Mr Jim Cunningham]

It is good of my hon. Friend to give way to colleagues. Does the situation not demonstrate that the Government’s intention—Governments do give contractors instructions, by the way—is to cut people’s benefits, and to make the system more difficult, through the contractors, so that it is harder for people to get those benefits? If anybody wants any evidence of that, it took the House of Lords to stop a £30 cut in people’s benefits a couple of weeks ago.

[Louise Haigh]

Absolutely. Clearly, there is an attempt by the Government to drive down benefits for people who are sick and disabled, and they are using private companies to outsource that responsibility.

Even if the Government were interested in ensuring that the contractors were doing the best for sick and vulnerable people, it would be very difficult for them to be able to do so. They need to be able to trust the data that the contractor supplies if they are to hold its feet to the fire. In a 2014 report, the NAO pulled the Government up on the poor management of contracts, the level of inexperience within Departments, their naivety and their “over-reliance” on data supplied by contractors in the management of performance.

Although some much-needed changes have been made since the calamitous Atos contract and that 2014 report, old habits die hard and inexperience in managing contracts remains a major issue for the Department. Although we know that contractors are performing poorly against a range of measures, because of the helpful insight we get from the NAO once in a while, assessment across the full range is not always forthcoming.

Across a range of vital measures, it is up to us to trust that the Department is doing the job and that Maximus is supplying the right information. They include the number of face-to-face complaints following an interview; the number of serious complaints; the percentage of face-to-face consultations without complaints, which is supposed to be at 99.5%; and the target of 100% payment of travel expenses within nine working days. Those targets are all noble and sensible, but there is no regular method for publishing whether they are met. That is why we talk about a democratic deficit in outsourced public services, the costs of which have rocketed since 2010 to almost £120 billion, covering vast swathes of services that we all rely on.

What exactly is the point in setting targets if the public cannot see whether they are being achieved? A supplier could manipulate the data, and we would have to rely on an overstretched Department to pick it up. Let us not pretend that that would be unusual or unprecedented. In 2007, Maximus was fined $30.5 million over accusations that it had cheated Medicaid in the United States by making tens of thousands of false claims on a payment by results contract. Maximus effectively stole money from US taxpayers by making claims for children who had not received care. After that was exposed, Maximus said it would not sign any more contingency-based contracts where it was paid from savings in state expenditure, but the contract we are discussing is just such a contingency-based payment by results contract.

In 2007, Maximus was sued by the state of Connecticut for the abject failure of its computer system, which was supposed to run a police database, including real-time police record checks. The state’s attorney general said:

“Maximus minimized quality—squandering millions of taxpayer dollars and shortchanging law enforcement agencies.”

He said that the database could

“make a life and death difference to police and other law enforcers”,

so the failure was unacceptable. In 2012, Maximus settled the case for $2.5 million. While the US sues companies such as Maximus, which spectacularly fail to deliver the contracts they are required to, we continue to hand over billions of pounds of taxpayers’ money.

We have an original policy based on a flawed and myopic view of the sick and disabled, and handed down by the Government to catch contractors that are undeniably failing. Meanwhile, the public’s right to know what is going on is limited by commercial confidentiality. We will all be forgiven for not wanting simply to trust that all is well when our constituents tell a different story and when well documented scandals seem to play on a loop.

Will the Minister commit to publishing regular updates to Parliament on Maximus’s performance against its targets? Will she release the latest spending on WCA appeals, given that the figures in the public domain date back to 2012, and when the contract comes up for renewal in three years’ time, will she release a cost-benefit analysis of bringing the service back in-house? Finally, will she confirm what steps are being taken to bolster the experience of civil servants in her Department overseeing contracts of this magnitude, to ensure that they are delivering the best possible service to vulnerable people and the best possible value for money to the taxpayer?

The fundamental problem is that regardless of which hapless and dubious provider is dragged in, and regardless of the operating system and oversight of the WCA, the need of extremely vulnerable individuals simply cannot come in third place behind a need to cut costs and maximise profit. Is not the lesson of this whole sorry episode and the episode before it that profit has no place in assessing need?