Welfare Reform Bill

Lord Patel Excerpts

Tuesday 14th February 2012 Lords Chamber

Moved by

[Lord Patel]

As an amendment to Motion F, at end insert “but do propose Amendment 18B as an amendment in lieu”,

18B: Page 36, line 35, at end insert—
“( ) In calculating for the purpose of subsection (1) or (2A) the length of the period for which a person is entitled to a contributory allowance, days in a period during which a person is receiving treatment for cancer or suffering from the effects of treatments for cancer are not to be counted.”

[Lord Patel]

My Lords, before I start, I would like to record my most sincere gratitude to the Minister for the courteous way in which he has engaged with me on many occasions to discuss all my amendments, but particularly this one. I found that our meeting was courteous, and he showed a clear understanding of the issues, so I thank him for that.

I was, of course, disappointed that the other House decided to overturn my amendment, particularly one that I thought was fairly modest, as Amendment 18 simply sought to protect cancer patients from the impact of time-limiting employment and support allowance. If the impact of the time-limiting proposal on cancer patients is to be mitigated, the Minister’s words in his summing up today will be of particular interest.

During the previous debate I indicated very briefly what it is like for patients to be on chemotherapy for prolonged periods of time, sometimes for as long as two years. I could not do enough justice to the description of how a patient feels, so I would rather use the actual words of a patient.

Jenni Russell, a reporter, wrote an article in the Sunday Times, and she had this to say:

“Everyone knows that cancer patients are likely to spend a lot of time being made to feel really … ill … I almost died of malaria in my twenties”—

I had malaria in my teens, and I can still remember what it felt like—

“but I have never felt as appalling as I did on chemo. The point of chemotherapy is to load the body with sufficient poison to kill the cancer without … killing the patient. It is crude medicine and, because we understand so little about genes or cancer pathways, it is unpredictable. I had assumed I would overcome it with a bit of willpower. Instead I had vomiting, nausea, headaches, muscle weakness and an inability to tolerate bright lights. For the first four days in every fortnight’s treatment, I couldn’t eat, speak, read, listen to the radio or get out of bed. My white blood cell count sank so low that I needed injections to boost my bone marrow production. For the next six days I was too weak to want to walk upstairs. There was no fight left in my body. … I could not conceivably have held down an ordinary office job over those months”.

This is despite the fact that she had had a lot of support. She goes on:

“The fact that working was a choice, not a fearful necessity, made a huge psychological difference. … I have no problem with the principle that people who can work should work”.

I think she is right. The vast majority of people with cancer who are out of work because of their condition want to work. For cancer patients, getting back to work is a crucial step forward in getting their lives back after cancer, but people with cancer often experience debilitating physical and psychological effects from the disease and its treatment. As I have described, these can be quite severe. For the majority of people with cancer who need ESA, 12 months is simply not long enough to return to work.

We hope there is consensus that cancer patients awaiting and undergoing cancer treatment should be in the support group. The Minister already referred to this, and I am grateful for that. I understand that following my discussions with the Minister and others, the Government are in discussions with Macmillan about how this process can be reviewed. Progress is being made, and I appreciate that very much. However, the primary concerns about the impact of time limiting on cancer patients have been that those who still experience the long-term effects of treatment will lose their benefit before they are ready to return to work. I hope the Minister will say something about that.

I am glad, however, that the Government are seeking to ensure that these people are given more time in the support group, where they will not be impacted by the time limit. If we are to protect cancer patients who are suffering from the debilitating side-effects of their treatment through the work capability assessment, it is crucial that the views of healthcare professionals—the oncologists, the GPs and the specialist nurses—are taken on board, and their evidence ought to suffice.

I hope that the Minister will refer to that. Patients often deteriorate after treatment is completed, hence my amendment, which says that those suffering from the effects of treatment should not be included. A system would be based on the presumption—and that word is important—that the cancer patient leaving the treatment phase would remain in the support group of the benefit if they needed it. Evidence from a healthcare professional would consist of confirmation that the cancer patient continues to experience side effects that limit a claimant’s capability to work, and therefore should be placed in the support group. I agree that this assessment could be reviewed after a suitable period—even after six months—to see how the claimant’s situation has changed.

I therefore sincerely hope that the Minister will be able to think of ways of meeting this amendment, and I look forward to hearing them.

[Baroness Morgan of Drefelin]

My Lords, I support the Motion of the noble Lord, Lord Patel, and in so doing I remind the House of my interest as chief executive of Breast Cancer Campaign. In particular I congratulate the noble Lord, Lord Patel, on pursuing his amendment and on articulating so clearly the concerns of cancer patients. I also congratulate Macmillan on the work that it has been doing very determinedly to raise these important issues on behalf of cancer patients, and I thank the Minister for listening and for being very careful in his response, as I am sure he will be.

I do not want to repeat the arguments that have already been made in this House on Report, but I would like to be very clear that I believe this House has made its intention very clear—with an alternative amendment—on the need to provide cancer patients with the security of having treatment without the pressure of potentially losing their benefit added to it, an issue that I suggested here today and that I would like to hear from the Minister on.

I would specifically welcome hearing from the Minister about the position of cancer patients who, by April 2012, will have been in the work-related activity group for 12 months. Will he clarify for us, in the light of his new thinking, whether this group of patients will no longer be eligible to receive contributory ESA? I know that the Government are consulting, and I understand that the Minister will not want to pre-empt the outcome of that consultation, but it would be very helpful for those who have received notice that their benefit will come to an end after 12 months to know, as cancer patients, what their position might be.

[Lord Avebury]

My Lords, perhaps I may intervene briefly and question the noble Lord, Lord Patel, about the breadth of his amendment. He spoke about those people who are receiving treatment for cancer and described vividly the ordeals that they go through when receiving chemotherapy. Of course, we all have knowledge of that kind of treatment, not from personal experience but from our relatives and friends who have been through those procedures. But not every cancer patient has to be given chemotherapy or radiotherapy. Some cancers can be treated with medication. I was speaking particularly about myeloproliferative disorders, which can be treated in the early stages with medication.

The wording of the amendment as regards “receiving treatment” is too broad and should be confined, for example, to those receiving chemotherapy or radiotherapy. In that way, the provision would be limited to those people who are so physically affected by the treatment that they are receiving that they would be incapable of working or unlikely to be capable of working until that treatment ceases.

[Lord Patel]

My Lords, it is true that some cancer patients may not need any treatment after surgery. But many others need therapy and my amendment refers particularly to those who cannot work because of their treatment or their suffering from the effects of the treatment. My key point is that those people want to work. As Jenni Russell said in her article, they are not skiving. They want to work. If the amendment is defective in that area, the purpose is not.

[Lord McKenzie of Luton]

My Lords, when our amendments were considered in the other place, the Minister, Chris Grayling, emphasised that the scope of the support group had been increased for cancer patients and that the consultation, following work with Macmillan Cancer Support and Professor Harrington, carried a presumption that someone with cancer will be in the support group. In an exchange with my right honourable friend Stephen Timms, the Minister also confirmed that it was planned to have a simple system that enables a medical professional to indicate whether someone has sufficiently recovered to make a return to work. That obviously is to be welcomed. It clearly goes with the grain of the amendment in lieu in the name of the noble Lord, Lord Patel, which has our support. He has set out the arguments clearly and the support of noble Lords would bring relief to up to 7,000 people who have or have had cancer.

We recognise that the Minister cannot pre-empt a consultation, but we hope that the Government can accept the thrust of what the noble Lord, Lord Patel, proposes. If he cannot, we hope that the noble Lord will test the opinion of the House. Bringing relief to some 7,000 cancer sufferers is a worthy endeavour. Of course, it does not of itself provide help to the hundreds of thousands who are adversely affected by the arbitrary time limit in contributory ESA but that should not prevent us bringing some relief to this group where that is possible.

--- Later in debate ---

[Lord Freud]

My Lords, I need to start by paying tribute to the noble Lord, Lord Patel, who has done some astonishing work in this area in bringing the issues vividly to life. We certainly have learnt and have appreciated some of the things that he has said. I hope that I will be able to give him and the House some reassurance about the progress we have made on this.

As noble Lords will know, we are committed to improving the WCA so that it accurately identifies the individuals who should be in the support group where there is no time limiting and no questions. That is why we asked Professor Harrington and Macmillan Cancer Support to look at the way in which individuals being treated for cancer are assessed. That is why we have proposed changes and those changes are what we are consulting on now.

The intention of our proposals is to introduce a presumption that most people being treated for cancer should be in the support group unless the evidence indicates that, exceptionally, the debilitating effects of treatment are likely to be more limited. We would expect this to increase the number of individuals going into the support group and to reduce the number of people called to attend a face-to-face assessment. We have been working closely with Macmillan Cancer Support as part of the consultation and to understand if, following the consultation, there are further areas where improvements need to be made.

I can report to noble Lords that our discussions with Macmillan Cancer Support have been constructive. As a result we have reached agreement in the following three areas, which I hope will deal with some of the searching questions raised by the noble Lord, Lord Patel. First, we have agreed that following the consultation we will work with Macmillan Cancer Support to develop the detailed guidance that underpins the regulations. Our aim is that the guidance should clearly specify the evidence required from a healthcare professional that would confirm presumption and allow immediate access to the support group without a face-to-face assessment. In our initial discussions we have agreed with Macmillan Cancer Support that evidence would be accepted from an oncologist, a GP or a specialist cancer nurse.

Secondly, we have agreed to review the guidance and process for people who are in the work-related activity group but whose condition deteriorates or relapses during the course of treatment so that they can access the support group quickly and smoothly. We would expect this to speed the process and reduce the need for face-to-face assessments. Thirdly, we have agreed with Macmillan Cancer Support to review the guidance for people who are in the recovery period following cancer treatment. That will ensure that individuals can remain in the support group for as long as appropriate during their recovery. Combining those three proposals will greatly improve the way we assess and support individuals suffering from cancer and reflect the particular challenges they face as a result of both the condition and the treatment.

As a result, we would expect that the majority of cancer patients are likely to be placed in the support group for the first six months while they undergo treatment. Following this, many are likely to have a further period in the support group while they recover from the residual effects of treatment. It could easily be up to a year therefore for many people with cancer before the clock starts running in relation to time-limiting. I know that the chief executive of Macmillan Cancer Support has welcomed these proposals and we look forward to working with his organisation following the consultation to help implement our proposals and to support people with cancer, where appropriate, to return to work.

Finally, in response to the noble Baroness, Lady Morgan, on the WRAG, we are looking at this in the round and it would be unwise to pre-empt the consultation. But, clearly, we would want to be in a position where those in the WRAG are genuinely able to do work-related activity. As I have said, we now presume that most people will end up in the support group for an extended period. On the basis of what I have said, I hope that the noble Lord, Lord Patel, will feel able to withdraw his amendment.

[Lord Patel]

My Lords, I thank the Minister for his very positive response. Like the noble Baroness, Lady Morgan, I pay tribute to the work Macmillan Cancer Support has done for cancer patients. To summarise, the Minister has been clear in accepting that the WCA assessment will be improved, that there will be a presumption that cancer patients in treatment will be in the support group, that discussions with Macmillan will continue following the consultation, and that guidance will be developed based on evidence from healthcare professionals to allow cancer patients either to remain in the WRAG or to go into the support group. He has also agreed to review guidance for patients in the WRAG so that if they deteriorate they can access the support group and to review guidance on the period of recovery following treatment. I have to say that it must be quite unusual to be content with the outcome on amendments on two successive days before two different Ministers. I thank the Minister very much for his summation. Cancer patients will be relieved. I am happy to withdraw the Motion.

Motion F1, as an amendment to Motion F, withdrawn.