Welfare Reform and Work Bill

Lord Layard Excerpts

Tuesday 17th November 2015 Lords Chamber

[Lord Layard (Lab)]

My Lords, I will make just one, completely simple, point. If you are on ESA because of mental illness, you are sick. If you are sick, you ought to be in treatment. It is an astonishing fact than under half of the people on ESA by virtue of mental illness are in any form of treatment: a crazy situation. If we really want to get these people back into work, the most important thing would be to help them get better. They should be in treatment and the purpose of the Bill should include the effort to get them into it.

So how can this be done? The vast majority of mentally ill people on ESA are suffering from depression or anxiety disorders. For all these conditions, NICE recommends the offer of psychological therapy. For severe depression and some anxiety disorders, it also recommends medication, but we know from the evidence that most patients would prefer psychological therapy. However, until 2008, NICE-recommended psychological therapy was hardly available at all on the NHS to this group of patients. Since then, however, the Improving Access to Psychological Therapies services have become available nationwide—partly due to the efforts of the noble Lord, Lord Lansley—and in the past 12 months these services saw nearly a million people.

Incidentally, the services have different names, and your Lordships may not always realise that what they are talking about and seeing is an IAPT service—I will just use the term IAPT. The key step, therefore, is to ensure that every person with depression or an anxiety disorder who is awarded ESA is referred to an IAPT service. I am planning to move an amendment—I hope in agreement with the Minister—to ensure that this happens. It should happen as automatically as possible, although we should allow the claimant to decline. We should make sure that this is an automatic part of the procedure.

The first step would be to get the claimant an assessment of his health problem. Your Lordships may not be aware of the extraordinary situation that, when people come on to ESA with depression or anxiety disorders, the vast majority will never have received a diagnosis of what is wrong with them and will have no specialist assessment of what their problem really is. They will have seen their GP, but for most of them that will be all, unless they have been referred to an IAPT service. What we need is a mechanism whereby all those coming on to ESA are automatically offered an assessment by the IAPT service locally and, following that, suitable psychological therapy. Ideally, this could all be arranged on the first day after the award of ESA, when the claimant is called to the jobcentre to be allocated to the Work Programme. Next they would be invited to go along the corridor to see Mrs or Mr So-and-so. This has to be the way to go.

By contrast, it has sometimes been suggested that we should create a separate system of psychological therapy for people whose mental health problems are affecting their employment. However, it would be extremely costly to build up a separate system; and when we have one system that is working well, that is what we should build on and use. But of course it needs improving. In particular, it needs to include professional employment support for those looking for work or at risk of job loss. This was a central feature of the original design for IAPT, which, in fact, prescribed one employment support worker for every eight therapists. Unfortunately, the Department for Work and Pensions objected to this suggestion by the Department of Health and said it was its own job to do it, but then it failed to get the money and the job did not get done at all. This is, roughly speaking, what has continued to the present day.

Fortunately, the Government—led by the Minister—have now piloted a system of individual placement and support, which will be introduced within the IAPT services. That is excellent news. Obviously, the best location for employment support workers is within the therapeutic team so that they can exchange their understanding of the claimants’ problems. However, for any of this to work, the claimants must first be referred to an IAPT service. As I said, half of them are not referred to anything and are in no treatment of any sort, so the key issue is to make that happen. But could the IAPT services cope with the extra numbers of people? The answer is yes, if the resources are provided. Of course, no alternative system could cope either without the resources being provided.

Where we are now is that the IAPT services are seeing 15% of all the adults in the community with depression and anxiety disorders. The Department of Health has proposed to the spending review that this should rise to 25% by 2020. In my view, expansion on that scale is vital, on the grounds of parity of esteem for the claimant and of simple, common-sense economics. When people recover from depression and anxiety disorders, there are massive savings in reduced welfare payments, increased tax receipts and reduced costs of physical healthcare. Our calculations are that if the proposed expansion from 15% to 25% is allowed to happen over the next five years, the public debt in Britain in 2020 will be £1 billion lower than if we did not have the expansion that we need to have. This is because clinicians recognise employment issues as an indicator of clinical priority. Work can be a major therapeutic agent. We can confidently say that the IAPT services would respond if they were given the job of treating this group of patients. The bigger doubt is about the willingness of the jobcentres to refer people; we have had a lot of trouble trying to make that happen. That is why we need legislation to ensure that a rational system of referral is put in place.

I know that the Minister is very interested in this issue and I hope that he can help us to devise a practical solution for the present absurd situation. What we have is taxpayers paying billions of pounds to people who are unable to work due to a treatable condition, for which they are not being treated. This cannot make any sense. It makes no sense for the people themselves, for whom it results in terrible hardship, or for the Exchequer. It is time that these people got the treatment that they desperately need.