Welfare Reform Bill

Lord Touhig Excerpts

Tuesday 17th January 2012 Lords Chamber

[Lord Addington]

The amendment on which mine is the lead name also refers to the autistic spectrum. When the noble Baroness is in the Chamber with us, I always feel as though you are definitely on the end of the passing movement, as opposed to being the play-maker. The noble Baroness knows exactly what she is talking about. At my conference, someone who was talking in a meeting about autism said, “You must understand that autism is a three-dimensional spectrum”. Does that phrase not start to explain why the diversity of people and their reactions are incredibly difficult to understand and always will be? I wish I had thought of that expression myself. The great diversity of needs and different types of behaviour mean that you must have some specific training.

When I was approached to put down this amendment, I had a conversation with the NAS. I want to use it as an example of the fact that you always need a certain degree of knowledge to make this type of assessment. I remember that, in years gone by, when the noble Baroness, Lady Hollis, spoke for the then Government, our exchanges on the subject of the initial interview process went on and on and developed almost into a ritual dance. “Can we have specific knowledge?”, we would ask the Government. “No, but we will give them lots of training”, they would reply. We have got better, because we always do, but it remains the case that unless you have someone who actually understands the condition which they are assessing and reporting on, they will make mistakes.

The noble Baroness, Lady Grey-Thompson, has already pointed out that mistakes cost “blood and gold” for everybody concerned. You burn up time; you burn up money; you cause suffering. Getting more expertise into assessment, either by taking a better history, or by making sure you have the right person there at the right time, will make life a lot easier and will probably save money in the long term or, indeed, in the medium term. The Minister has been moving forward, although he is pushing water uphill with certain concerns here. I stress that I am looking for clarification on where he is moving to and his thoughts on where this expertise is going to be dragged in. If you have a problem, empower people to say that there is a problem and that someone who understands it needs to be brought in. If you can do that, you will take huge steps forward. You will not get it right all the time but you will get it right more often.

If the Minister can give us some encouragement and some firm guidelines about what is going to happen to encourage people to get it right—not just to get the numbers through—I will be a very much happier man at the end of this.

[Lord Touhig]

My Lords, I do not intend to detain the House long, because Amendments 50B, 50C and 50D were debated at some length in Committee. I attempted to withdraw Amendment 50A yesterday, but the gremlins crept in and the only thing that has been withdrawn is my name—the amendment still appears on the Marshalled List.

With Amendment 50B, the noble Lord, Lord Addington, has once again made a very powerful case in support of the need for properly trained assessors. In particular, all assessors should have an understanding of and training in autism if they are to recognise and understand the complex cases they will have to deal with. It has been said a number of times—I make no apology for repeating it here, because it is important—that when you have seen one person with autism, you have seen one person with autism. This is why the training is so important. A knowledge of autism and possessing the right skills to assess the needs of an autistic person are essential in making any decision about the appropriate level of financial support that that person might need. I believe that the Minister accepts this point of view.

Following the Committee stage, a number of other noble Lords and I had a very useful meeting with the Minister and his colleague Maria Miller MP, and we are grateful for that opportunity to exchange views in a less formal situation. One point from that discussion, which was touched on today by the noble Baroness, Lady Browning, did concern me—the point about the qualifications of the person carrying out the initial assessment. One of the Minister’s officials told us at that meeting that the initial assessments would be carried out by an occupational therapist. Will this be the case? That seems a very narrow skill base from which to draw the expertise for any kind of wider assessment, and it leaves me, for one, with the impression that the assessment is aimed primarily at getting people into work and not at trying to understand and support them if they are not able to work. Such a situation would fly in the face of the well-argued case that assessors should have specific training in all mental, intellectual and cognitive disorders, as advocated by the amendment. I hope the Minister can allay my fears.

I turn to Amendments 50C and 50D, in my name and that of my noble friends Lady Healy of Primrose Hill and Lord Wigley. The amendments concern face-to-face assessment and would, if accepted, exempt certain categories of people from the process of continuous reassessment where sufficient medical and other expert evidence existed to demonstrate that their condition would not improve. I return again to my concerns about people with autism. Autism can be summed up in this way: autism is for life. Any reassessment must accept this fact before progress can be made. The Minister made it clear, at Second Reading and in Committee, that the Government did not believe that a face-to-face assessment would be the right course to follow in all cases.

At our meeting, both the Minister and his colleague, Maria Miller MP, gave a strong impression that the Government would support a tiered approach to assessment in such cases, as advocated by the National Autistic Society and others. In practice, this tiered approach would allow for written assessment from professionals to be considered and a decision to be made, on that basis, about whether a face-to-face assessment was appropriate or necessary. I will not test the patience of the House any longer. I look forward to the Minister’s response and hope he will have something positive to say about a tiered assessment.

[Lord Kirkwood of Kirkhope]

This is an important debate because existing relevant medical evidence is absolutely essential to getting this test—and the whole process—delivered as accurately and as sweetly as it possibly can be. This is true in two separate directions. First, getting access to and active consideration of existing relevant medical evidence will make the examination—if an examination is needed—much more satisfactory for all concerned. As has already been said, it will reduce appeals—and it will minimise costs for that reason if for no other.

It has a second important function which I hope the Minister will be able to spend some time on. If the Minister could help us understand better how desktop assessments can obviate face-to-face assessments, he could diminish the fear factor that clearly exists, rightly or wrongly, about what will face people who might be invited to these face-to-face tests in future, and that would be enormously helpful. I am aware, having followed this for some time, that the DLA provisions which we put in the primary legislation in 1992 were, in some respects, too prescriptive. I understand perfectly that assurances can be made and put into regulations and put into medical contracts as well.

I am in the market for voting for this amendment if we do not get the kind of response that I hope for. However, there are ways of delivering the assurances that are being sought by our correspondents and the disability community. It would be helpful if the Minister could say a word about the contract. I understand that the contract is out to tender and it is too early to say who is interested, but people are drawing conclusions from the Atos Healthcare experience. I do not think that that experience would necessarily be repeated in the future if the terms of the contract are drawn sufficiently clearly. In that contract, if not in regulations or primary legislation, we should be saying clearly that on cause shown, if there is heavyweight medical evidence that can be addressed at a desktop level, those are circumstances where it should almost be a default that people will not be subjected—if that is the right verb—to these assessments.

I share a concern about the quality and experience of the assessors. I have a capacity issue as well as a quality issue about that. It does not matter if you get the best contract in the world and the most enthusiastic prime contractors who come in and promise, hand on heart, to do the best they can. The professionals with the right qualifications and experience to do this work may not be out there. If that is the case then we need to be very careful. There is not enough emphasis in the United Kingdom on this kind of medicine, and we should be promoting with our medical colleagues a far higher degree of interest in and development of the specialist skills that medical professionals need to do these jobs in order to make this process a success.

I have here a case history that caught my imagination. A 25 year-old young man is undergoing his first major reassessment of his problems as an adult. His assessments will involve MR scans, examination by neurologists, neurogeneticists, neurophysiotherapists and a specialised occupational therapist. He has scattered neuromotor difficulties. Although I trained as a pharmacist a long time ago, I could not even find on the internet what neuromotor difficulties actually amount to, but it is clearly a serious condition that is being addressed by experts at a tertiary, if not international, level by a centre of excellence in a region in the United Kingdom. The young man has written to say that he is now fearful that he will have to address the circumstances of these tests. It would be completely daft and stone mad that we cannot say something now that is clear. There may be technicalities with the legislation, and perhaps I could be persuaded that such provisions should not be in primary legislation, but we absolutely need some clear, copper-bottomed assurances from the Minister that a person in those circumstances would not face such difficulties.

I hope that the Minister will understand that this is an important amendment and that he will take as much time as he can to tell us as much as he knows about how these processes will work and where in the legislative process—whether by regulation or primary legislation—we can be assured that we will get some protection for the kind of young person to whom I alluded.