Ten Years of the Work Capability Assessment

Justin Tomlinson Excerpts

Wednesday 24th April 2019 Westminster Hall

[The Minister for Disabled People, Health and Work (Justin Tomlinson)]

It is a pleasure to serve under your chairmanship, Sir Henry; you have expertly managed the timekeeping. I pay tribute to the hon. Member for North West Durham (Laura Pidcock). I know this is an area that she has campaigned on since she was first elected, and she does so with real passion and a determination to see improvements right across the system. That was echoed by all speakers. I might not have agreed with absolutely every point—hon. Members would not expect me to—but it is clear that there is a real desire to see continued improvement and an emphasis on how important that improvement is to people who are going through the process.

The hon. Member for Lincoln (Karen Lee) highlighted a particular story, which I was very touched by. I would like to meet her to discuss it further, as I think there are lessons to be learned from that case. I am certainly sorry for the experience that person has gone through.

This area is a real priority for me. I have been the Minister for Disabled People before, when I was a Parliamentary Under-Secretary. I have been an elected representative for 19 years, so I recognise the comments—we see first-hand through our casework instances where things have not gone right. I have spent my parliamentary career being proactive, working with MPs across the House, and stakeholders, charities and experts in this area. I listen to what is said, I try to do my best to make improvements and I certainly hope that that was reflected in my record as Minister for Disabled People last time. I will continue in the same vein.

The Government are focused on this area, and we have rightly increased funding for those with disabilities and long-term health conditions. This year, we are expected to spend £55 billion, which is a £10 billion increase in real terms since we came to office. It is a record high and it is 2.5% of GDP, which is higher than the spend of any other G7 country. It is 6% of total Government spending, and I think every penny is rightly supported by the wider public.

The debate today is focused on the 10-year anniversary of the work capability assessment, which I note a few speakers did acknowledge was introduced by the last Labour Government. Clearly, it was not perfect and there has been much-needed improvement since its introduction. We are all committed to playing our part in improving the process and to taking account of the developments in healthcare, modern workplaces and flexible working arrangements.

Backing up those improvements were the five independent reviews. The first three were carried out by Professor Harrington and the final two were carried out by Dr Litchfield. More than 100 recommendations were made that we have accepted and delivered. As the Secretary of State set out in her recent speech, we need to do more, and that is a real priority.

Many people have highlighted concerns with the frontline staff and process. Since 2015, the Centre for Health and Disability Assessments has taken over the delivery of the work capability assessment, and the focus has been on improving the operational process. It has increased the number of healthcare professionals by 82% and 1,300 staff are now directly involved in supporting assessments. It has increased the number of assessment rooms and significantly improved the training programme—many speakers highlighted these issues, in particular in relation to individual conditions. There is broad training on disability analysis and on specific conditions, including multiple and complex conditions, which covers three distinct areas—principles and professional standards; the assessment process; and scrutiny and file work, with an emphasis on quality. Training is predominantly modular, with competency testing at every stage. The healthcare professional must then undergo the continuing medical education programme and is subject to regular case reviews and audits. For complex cases, we expect the healthcare professional to refresh knowledge prior to the assessment.

One very important and welcome addition that has begun to be rolled out is the introduction of customer champions. I absolutely recognise just how anxious and nervous people can be when going for assessment. I absolutely get that. The customer champion can assist those claimants, before and after assessments, to ensure that they receive the best service. We have had good feedback on that, and the intention is that there will be one in every single assessment centre.

I also recognise the comments about communication—the brown envelopes coming through. There is a commitment from me to work further with stakeholders to improve the letters that come out. I have seen this as a constituency MP; I have taken a deep breath at the poor quality of some communications. We need to improve that.

[Karen Lee]

Does the Minister agree that subjecting people who have either a chronic illness, such as multiple sclerosis, or a terminal illness to these kinds of work capability assessments is totally unacceptable?

[Justin Tomlinson]

I cannot give a broad-brush answer. I know what the hon. Lady is saying and I am coming on to the use of evidence and how we can do more earlier and, potentially, then with paper-based assessments. I will come on to that. I understand, but I cannot give a definitive answer, because every claimant has their own unique challenges that have to be addressed.

In addition, SMS text message reminders about appointments have been welcomed, and there has been a lot of work on the website, which includes mock assessment videos so that people can get an idea of the sort of things to expect. Those things are all looking to remove some of the anxiety and worry about assessments. There is more to be done in that area, but we recognise that.

The improvements in the training and the extra healthcare professionals have meant that median clearance time halved from 25 weeks in March 2015 to 10 weeks in 2018, and customer satisfaction has exceeded the 92% target since that point. However, that does not mean that we are getting it right every time, and that is what I want to turn to now in focusing on MR and appeals.

All of us as Members are frustrated when what seem to be clear-cut cases come to our constituency surgeries asking for our help. There are times when we think, “How on earth can this have happened?”, and ultimately the person could have a very long appeal process to go through to get the right decision. In the majority of cases, appeals are successful because of additional oral and written evidence. That has to be addressed. We rightly are going to tackle it and will do so in two stages—first, with the MR process. We have started doing this with PIP. We are seeking to contact the claimant who is disputing a decision and talk to them directly to get the additional oral and, potentially, written evidence at that stage to see whether we can improve decisions at that point, rather than waiting for the evidence to come at the end of the appeal process.

[Debbie Abrahams]

Does the Minister think that it is unacceptable that any Government policy should cause their citizens to take their own life or to die? If he does, should there not be a moratorium on this policy until it is got right? Surely one death is one too many.

--- Later in debate ---

[Justin Tomlinson]

We all recognise that suicide is a tragic and complex issue, and we take it extremely seriously. We take the death of any claimant seriously and, where we are made aware that a person has died and it is suggested that that might be associated with the DWP directly, a review will be undertaken to identify whether any lessons can be learned and can be actioned.

[Patricia Gibson]

Will the Minister give way?

[Justin Tomlinson]

Let me make some progress, because this is a very important point about the MR process. We are in the early stages with a new way of looking at MRs, but there have been very positive results, and we will now roll this out to all the PIP dispute sites. We intend to do the same for the ESA sites as well.

The second stage has to do with the appeal process. Again, we recognise that people will submit additional, late written and oral evidence.

[Patricia Gibson]

rose—

[Justin Tomlinson]

Let me just make this point. I want to explain one of the challenges. The shadow Minister, the hon. Member for Battersea (Marsha De Cordova), talked about a 30-week wait, in some cases, for an appeal. The person may have got the additional evidence in week six, but then the system is saying, “I’m sorry, but you’re going to have wait another 24 weeks until we can actually take that into account.” That is clearly not an ideal situation, so we are looking at how we can lapse appeals, where there is new evidence, to reconsider the decision with the additional evidence and be able then to give them a different decision. If we do not think that that should change the decision, they have the right to carry on right through to the final appeal process, but if it is something that is clearly going to change the decision, we should act as quickly as possible.

[Patricia Gibson]

Will the Minister give way?

[Justin Tomlinson]

In a second. Over the past five years, only 4% of work capability assessment ESA decisions have been revised at appeal, but we recognise that it is in no one’s interest that things should be picked up only after a lengthy appeal process, so we are absolutely committed to being proactive in this area, and this issue will be a real priority.

[Patricia Gibson]

I thank the Minister for giving way. I just wanted to ask for clarification on one point that he made, which was about appeals being successful because of new or additional information. How does he respond, then, to the fact that people who go on to appeal do so on the basis that the information that they see about themselves is badly or very badly expressed and incorrect, and to Citizens Advice saying that 81% of the customers it sees have inaccurate information recorded about them, which leads to a wrong decision?

[Justin Tomlinson]

I am coming on to how we can do more to ensure that the right evidence is put into the system at the earliest possible moment and in the right way. We do not want people who should be getting support to have to go through a lengthy process unnecessarily. We all agree on that, and I hope that hon. Members can see that what I am describing is an important improvement. It is still at an early stage, but as I have seen in previous debates, it is the sort of thing that stakeholders want us to do, and we are rightly going to take it forward.

Let me come on to the point about evidence. It is referring to the integrated service. There is a bit of confusion in terms of what people thought that this would be. The view was that it ultimately would be a panacea whereby people would go for one single assessment for PIP and for the work capability assessment. The reality is that very few people apply for both benefits at a similar point in time. However, for the very few people who do, it might make sense for them to have, if they wish, both of the assessments on the same day instead of having to come in on the Monday and then again on the Wednesday. That may be what people want to do, but we are talking about very small numbers.

The thrust of this is to share evidence if the claimant wishes that to be done. One point that many hon. Members made was about the challenge that often arises of getting the evidence, whether from the GP, the physiotherapist or the hospitals, in a timely manner and in a way that is helpful for their assessment. If they have managed to do that once and they would like us to use that evidence again, with their consent, that is something that we would seek to do as part of building the new digital system and ensuring that the claimant has consistent, better information. Being able to share evidence will reduce the burden of providing the same evidence multiple times. It could potentially lead to fewer face-to-face assessments if we can gather crucial, vital, clear-cut evidence earlier in the claim.

I want to pay tribute to all the stakeholders, the medical experts, the charities and all the MPs across the House who regularly engage on this issue. Over the coming months, we will be doing a series of roundtables and regional events to gather further evidence, with a real emphasis on those with real experience of this area, so that we can further improve the system. We want to build trust, transparency and consistency and we want to improve the claimant’s experience through a more personalised and tailored approach. As a returning Minister, I am committed to supporting disabled people and those with long-term health conditions to claim and receive the benefits to which they are entitled and to ensuring that people are treated fairly and with dignity. I thank all the Members across the House who have contributed today.