Ten Years of the Work Capability Assessment

Karen Lee Excerpts

Wednesday 24th April 2019 Westminster Hall

[Karen Lee (Lincoln) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Henry. I congratulate my hon. Friend the Member for North West Durham (Laura Pidcock) on securing the debate, and on her excellent speech.

My office was involved in a work capability tribunal case last Wednesday and I have obtained permission from the person involved to discuss publicly what she has gone through because of such assessments. Sophie is the daughter of a friend of mine. Her mum and I trained 20 years ago as nurses and we worked all those years together on a ward at Lincoln County Hospital, so I know her really well. I provided Sophie with a letter for her tribunal, as her MP, as a qualified nurse and as someone who has known her for 20 years, before and after her diagnosis of multiple sclerosis.

Sophie tries hard to live as normal a life as she can, but I have seen how her illness affects her ability to do that day to day. She is just 30 years old and she was diagnosed with relapsing remitting multiple sclerosis at the age of 16 when she first developed balance difficulties. Over the following years she has developed problems with weakness, particularly on the right side of her body, as well as urinary difficulties, pain, fatigue and visual problems. She uses a wheelchair and struggles with mobility.

We went on a hen weekend in February; Sophie is my friend’s best friend, and we were in Boston. Everywhere we went she was in a wheelchair, and she simply cannot get out and about on her own. Whereas some patients with relapsing MS are unaffected between attacks, Sophie has chronic symptoms and is affected by her MS every day. The symptoms fluctuate markedly, and even mild infections and changes in temperature can make things much worse. There were complications during a trial treatment—I remember Alison and I and a few of us looked really hard to try to get her on trials to control what she had. There was a drug called alemtuzumab. Sophie now has an overactive thyroid and has to have regular blood tests to monitor her blood levels of thyroxine.

Sophie left school at 18 and trained as a nursery nurse. She worked at a nursery. She loved that job; it was one of her bits of normal. Eventually, though, she had to give up her job because of her MS, and after being forced by her disability to do that she applied for employment and support allowance benefits.

Recently, after a medical review, Sophie was deemed fit to work. The reasons given were that she has no problem with balance, uses public transport on her own and takes herself places independently. The truth is that she wears a support on one of her legs at all times, as I saw when we stayed for the weekend in February, because she drags the leg as she walks. She has to use a wheelchair every time she goes out of the house. She cannot walk any but short distances indoors, so how she is supposed to use public transport is totally beyond me.

The person who completed the assessment was allegedly competent to do it. Yet at the tribunal last week, those hearing the evidence seemed surprised that the case ever got as far as a tribunal and dismissed it in less than 10 minutes. They said something about a level 2 out of 3; I do not understand the terminology—but that is how ill Sophie is, although she had been deemed fit to work.

When someone is deemed fit to work, the process is that they have to appeal the decision if they feel it is wrong. Sophie appealed, but her appeal was dismissed because, I am told, the only evidence that the DWP will consider is the examination on the day, which came to such worryingly inaccurate conclusions. Sophie was therefore forced to take her case to a tribunal. That was eventually successful, but she should never have been put through such an anxiety-inducing ordeal. She is pregnant—she has a little boy of two and is about eight months pregnant, and the assessment came on top of all those other things in her life. I am sorry—it gets really upsetting, because I know her and what has happened to her is disgusting.

For people like Sophie it feels as if the DUP—[Interruption.]—I am sorry. That was a Freudian slip, and I meant no offence. It feels as if the DWP is working backwards from the conclusion that they are fit to work, regardless of the severity of their disability. That practice must end. Support must be given to the most vulnerable in society.

It has become popular in recent years to demonise those who are forced to claim benefits—to label them as somehow being scroungers or as faking their disability. Just after Christmas, I watched “I, Daniel Blake” on TV, and a prominent Conservative MP said on Twitter that it is only a film, but actually it mirrors real life, and people need to realise that. It is high time that the Government woke up to the fact that the vulnerable in society are suffering because of what they have done to our welfare system. It is meant to be the safety net for those who need it. People say that the mark of a decent society is how it looks after its vulnerable people. I am sorry, Sir Henry, but at present the reality is that the system is broken.

--- Later in debate ---

[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.