Work Capability Assessments

Louise Haigh Excerpts

Tuesday 9th February 2016 Westminster Hall

[Louise Haigh (Sheffield, Heeley) (Lab)]

I beg to move,

That this House has considered work capability assessments.

It is a great pleasure to serve under your chairmanship, Mrs Moon, and to lead this debate, because it is one that we have been having in the House for many years and it has enormous repercussions for the people we are here to represent.

The debate comes at an important time. The amount of money that the Government spend on outsourcing has never been higher, but public trust in outsourced companies has never been lower. Only 22% of people believe that they are motivated by providing the best service to the public, and is it any wonder, with stories every week of high-profile failures, corruption, mistreatment, the falsifying of information and a premium being put on profit ahead of people? There is a sense from the public that this shadow state, providing the services that the public rely on, is acting with ever increasing impunity.

In the course of the last Parliament, as outsourcing grew, the public’s control over our own public services shrank and evidence of malpractice, mistreatment and utter contempt for those coming into contact with the services provided by such companies grew, private sector providers became the ogres for their appalling behaviour. However, we should not forget that it resulted from what were first and foremost political choices, the unpalatable consequences of which were contracted out and covered in the veil of secrecy that commercial confidentiality rules permit. Although it was Atos and is now Maximus that has carried out the Government’s massive expansion of work capability assessments, the choices made in the Treasury and in Downing Street, well before responsibility was contracted out, were the basis for where we are today—failing contractors acting with impunity, and the sick and disabled paying the price for the Government’s flawed agenda.

Hon. Members on both sides of the House agree that if people can work, they should—that is not a contentious statement—and that work is beneficial for many people suffering from illness, be it physical or mental. I have friends and family who have fallen in and out of depression and for whom work has been a lifeline. It gives people a routine and a purpose—a reason to get out of bed in the morning. I have been unemployed for stretches of time myself and have experienced how closely linked unemployment and depression can be for many. Helping people to get into work is therefore a laudable and necessary objective of any Government, but some things are not compatible with helping people with physical illness, disabilities or mental health problems to get into appropriate work. I am referring to targets, profit-driven motives and a focus above all on cutting expenditure. When one side is trying to cut costs and another is employed to maximise profit, something has to give, and unforgivably that has been the sick, the disabled and anyone who comes into contact with this failing and occasionally brutal system.

[Neil Coyle (Bermondsey and Old Southwark) (Lab)]

I thank my hon. Friend for securing the debate. Is there not also an issue about the significant waste of taxpayers’ money in the Government failing to address the fundamental flaws in the system, which lead to an over-reliance on appeals and reconsiderations and the Department for Work and Pensions having to prop up a private company that is failing to deal with assessments appropriately the first time?

[Louise Haigh]

I could not agree more, and I will come on to that issue.

This is about providing not just a good-quality service for clients, but best value for money for the taxpayer. As I said, when one side is trying to cut costs and another is employed to maximise profit, something has to give. As report after report has identified, the contractors that the Government have employed to carry out cuts have been anything but successful. They have presided over failure after failure. There has been poor performance, a disregard for vulnerable people and, in this new age of outsourcing, a total lack of accountability for Government and operator alike.

[Mr Jim Cunningham (Coventry South) (Lab)]

I congratulate my hon. Friend on securing this timely debate. The cost to the taxpayer is some £80 million this year, up by £24 million on last year. Does she agree that these private companies are taking the taxpayer for a ride?

[Louise Haigh]

Again, I completely agree with my hon. Friend, and I thank him for that intervention. The contractors continue to get paid despite repeated failures. Even worse, after being deemed unfit to perform in relation to one contract, contractors simply get to continue with another lucrative long-term deal, as Atos has done. After failing to handle the work capability assessments contract, it is still running a seven-year contract for personal independence payment assessments for the same Department. Now Maximus is failing to meet a range of key targets—targets that, importantly, put far greater emphasis on saving money than on meeting the needs of people who unjustifiably suffer. Whatever the rhetoric about service quality, this is still a system designed to cut costs for the Government and maximise profit for Maximus.

We have undoubtedly all read last month’s report by the National Audit Office, but some of the figures deserve to be rehearsed. Despite the new contract—which followed Atos’s spectacular failure—being worth some £570 million a year, there is still a backlog of 280,000 employment and support allowance claims. The average cost of each individual assessment is now almost £200, and that is for a 15-minute assessment. One in 10 disability benefit claimants’ reports are rejected as below standard by the Government, compared with one in 25 when the shamed Atos was running the show.

Individuals have to wait an average of 23 weeks for a decision to be made on their benefits; there has been a huge rise in that timescale—almost a trebling—in recent years. For each person, that can and almost always does mean hardship, but the number being referred keeps rocketing as the Government, desperate to clear the books at any cost, lay the bill for clearing the deficit squarely at the door of the sick and disabled. The Government are forcing away from ESA people who need and rely on it, and the failing contractors are being overwhelmed. Despite all that undeniable pain, unbelievably, the Department is not expected to meet the initial £5.4 billion savings target originally envisaged for the 10 years to 2019-20.

[Neil Coyle]

I thank my hon. Friend for generously giving way again. Does she agree that the failure at ministerial level to get a grip on the backlog, the rising costs and the incompetence in the Department for Work and Pensions has led to the Treasury’s demand to take even more money from disabled people on employment and support allowance, which is why the Government are seeking to cut £30 a week from half a million of the most disadvantaged people in the country?

[Louise Haigh]

Again, my hon. Friend has neatly anticipated my next point, which is that the Office for Budget Responsibility has identified ESA and PIP as a major risk to planned public spending targets, given the uncertainty of the estimates. The NAO has gone so far as to say that PIP and disability living allowance performance issues have been the main contributing factor in the Department’s inability to save any money in the spending review period up to 2015.

It is clear that both the Government and contractors are failing on their own terms, yet still the cash is handed over to failing contractors. We are locked into long contracts whereby Departments do not have the capability to improve performance. The original policy itself is flawed, but it is in the treatment of individuals unlucky enough to come into contact with the system that the whole rotten trade-off between cost cutting by the Government and profit maximisation by Maximus is most apparent. Specific cases abound, and I am sure that hon. Members on both sides of the House would be able to relay evidence of deeply concerning practice, which is why it is interesting to note that not a single Government Back Bencher is in the Chamber today. I will list a few from my case load.

One man with learning difficulties whose case was highlighted to me attended his work capability assessment, but during the assessment his support worker was shocked at the lack of care and attention given to him. When the assessment came through, there were some glaring factual errors, but none the less his ESA was docked, just in case he was in any doubt about what comes first—the person or the profit. On making his request for mandatory reconsideration, he was appalled to find out that he would be ineligible for ESA, which was his lifeline, until the reconsideration decision was made, and he was unable to meet the conditions placed on him for jobseeker’s allowance. He now faces months of waiting until his tribunal, and potentially an annual battle if assessors continue to lack understanding of his learning difficulty.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Whatever my hon. Friend’s views about the contractors, does she agree that it is the Government’s responsibility to secure contractors whose assessors have sufficient knowledge of progressive conditions such as muscular dystrophy and sufficient awareness and training in areas such as learning disabilities? The contractors are not primarily responsible for that; is it not the Government’s responsibility?

[Louise Haigh]

Of course, I completely agree. The Government’s policy sets the direction for the contractors, which is why the contractors have such a huge gap in their understanding, particularly of mental health issues.

In another case, one of my constituents applied for a home visit after being unable to make their assessment. She has now been waiting for more than two years and still has not received a date. Throughout that time, she has been surviving on a reduced rate and is struggling, as anyone would, to get by. She is just one of 280,000 people in an enormous backlog.

Despite the fact that the Government have made it notably harder for people to appeal their decisions, as my hon. Friend the Member for Bermondsey and Old Southwark (Neil Coyle) mentioned, the latest figures show that 54% of appeals result in decisions being overturned. As in the case of the first constituent I mentioned, there seems to be an alarming trend of cases being rejected based on factual errors or even—I hesitate to say this—falsification. I have had several cases of people telling me that their assessment report bears absolutely no relation to the assessment that they experienced with Maximus or Atos. I am sure that other hon. Members have heard similar evidence. One or two cases could be dismissed as an honest mistake, but the situation appears to reveal a disconcerting pattern of behaviour that indicates that the trade-off between cost cutting and profit maximisation is being felt by very vulnerable people.

Maximus is not doing this to make a loss or out of the kindness of its heart, and it is failing on performance, which goes to the heart of the issue. Even if the Government were more concerned with the interests and wellbeing of the user, it would be extremely difficult for them to hold the contractors’ feet to the fire.

[Mr Jim Cunningham]

It is good of my hon. Friend to give way to colleagues. Does the situation not demonstrate that the Government’s intention—Governments do give contractors instructions, by the way—is to cut people’s benefits, and to make the system more difficult, through the contractors, so that it is harder for people to get those benefits? If anybody wants any evidence of that, it took the House of Lords to stop a £30 cut in people’s benefits a couple of weeks ago.

[Louise Haigh]

Absolutely. Clearly, there is an attempt by the Government to drive down benefits for people who are sick and disabled, and they are using private companies to outsource that responsibility.

Even if the Government were interested in ensuring that the contractors were doing the best for sick and vulnerable people, it would be very difficult for them to be able to do so. They need to be able to trust the data that the contractor supplies if they are to hold its feet to the fire. In a 2014 report, the NAO pulled the Government up on the poor management of contracts, the level of inexperience within Departments, their naivety and their “over-reliance” on data supplied by contractors in the management of performance.

Although some much-needed changes have been made since the calamitous Atos contract and that 2014 report, old habits die hard and inexperience in managing contracts remains a major issue for the Department. Although we know that contractors are performing poorly against a range of measures, because of the helpful insight we get from the NAO once in a while, assessment across the full range is not always forthcoming.

Across a range of vital measures, it is up to us to trust that the Department is doing the job and that Maximus is supplying the right information. They include the number of face-to-face complaints following an interview; the number of serious complaints; the percentage of face-to-face consultations without complaints, which is supposed to be at 99.5%; and the target of 100% payment of travel expenses within nine working days. Those targets are all noble and sensible, but there is no regular method for publishing whether they are met. That is why we talk about a democratic deficit in outsourced public services, the costs of which have rocketed since 2010 to almost £120 billion, covering vast swathes of services that we all rely on.

What exactly is the point in setting targets if the public cannot see whether they are being achieved? A supplier could manipulate the data, and we would have to rely on an overstretched Department to pick it up. Let us not pretend that that would be unusual or unprecedented. In 2007, Maximus was fined $30.5 million over accusations that it had cheated Medicaid in the United States by making tens of thousands of false claims on a payment by results contract. Maximus effectively stole money from US taxpayers by making claims for children who had not received care. After that was exposed, Maximus said it would not sign any more contingency-based contracts where it was paid from savings in state expenditure, but the contract we are discussing is just such a contingency-based payment by results contract.

In 2007, Maximus was sued by the state of Connecticut for the abject failure of its computer system, which was supposed to run a police database, including real-time police record checks. The state’s attorney general said:

“Maximus minimized quality—squandering millions of taxpayer dollars and shortchanging law enforcement agencies.”

He said that the database could

“make a life and death difference to police and other law enforcers”,

so the failure was unacceptable. In 2012, Maximus settled the case for $2.5 million. While the US sues companies such as Maximus, which spectacularly fail to deliver the contracts they are required to, we continue to hand over billions of pounds of taxpayers’ money.

We have an original policy based on a flawed and myopic view of the sick and disabled, and handed down by the Government to catch contractors that are undeniably failing. Meanwhile, the public’s right to know what is going on is limited by commercial confidentiality. We will all be forgiven for not wanting simply to trust that all is well when our constituents tell a different story and when well documented scandals seem to play on a loop.

Will the Minister commit to publishing regular updates to Parliament on Maximus’s performance against its targets? Will she release the latest spending on WCA appeals, given that the figures in the public domain date back to 2012, and when the contract comes up for renewal in three years’ time, will she release a cost-benefit analysis of bringing the service back in-house? Finally, will she confirm what steps are being taken to bolster the experience of civil servants in her Department overseeing contracts of this magnitude, to ensure that they are delivering the best possible service to vulnerable people and the best possible value for money to the taxpayer?

The fundamental problem is that regardless of which hapless and dubious provider is dragged in, and regardless of the operating system and oversight of the WCA, the need of extremely vulnerable individuals simply cannot come in third place behind a need to cut costs and maximise profit. Is not the lesson of this whole sorry episode and the episode before it that profit has no place in assessing need?

--- Later in debate ---

[Priti Patel]

It is fair to say—this will link to many of the forthcoming reforms in the White Paper—that we have implemented many of the recommendations. On top of that, we will continue to review them and work with the system. Any system of financial support for people who are not able to work needs to have a reliable method of assessing entitlement to that support. That is the basis of this afternoon’s debate.

I will talk about the current provider before I address the points about contracting that were raised by the hon. Member for Sheffield, Heeley (Louise Haigh). Since the Centre for Health and Disability Assessment, known as CHDA, took over the contract to carry out assessments in March 2015, it has made a number of improvements to the claimants’ experience of assessments. It has focused on increasing the number of healthcare professionals by 39% since March 2015, and it has opened up 100 new assessment rooms, so that it can see more people in more locations. I do not want to rehearse many of the points already made in the debate, but a lot of the focus has been on the new contracting arrangements with CHDA, which has reduced the backlog of assessments by 62%. It has also introduced claimant-focused improvements, including setting up a customer representative group with leading charities that have regular meetings with the chief executive and clinical leadership team.

There is also a focus, because we are speaking about people and the experience of individuals going through the process, on rolling out greater disability awareness training for all staff. The recent National Audit Office report acknowledges the progress that has been made in improving contracted-out health and disability assessments, and we have taken steps to help people with mental health conditions in their assessments following the reviews. We have trialled new awareness training for administrative staff that will now be rolled out nationally. We are also improving services on telephone engagement and how claimants are assisted; and that level of interaction has improved.

I want to address the points about contracting, which the hon. Member for Sheffield, Heeley focused on. I hope she will forgive me because I cannot speak about Maximus in 2007 and what took place in America, but I must make it abundantly clear that there is a full and transparent contracting process, undertaken with a negotiated procedure to enable the Department for Work and Pensions to fully test bidders and their propositions to meet the objectives for service delivery. I am speaking about the previous contractor, Atos, and the improvements that we seek under the new contract with CHDA.

[Louise Haigh]

I am grateful to the Minister for giving way and for her response so far, but is she seriously saying that previous fraud and theft from taxpayers cannot be taken into consideration when the Government are handing out a very similar contract in the UK?

[Priti Patel]

I cannot speak specifically to previous contracting processes and bids that took place outside the United Kingdom—it is not for me to comment on—but let us be clear. The Department is responsible for hundreds of billions of pounds of public money—taxpayers’ money. On our processes of procurement, renegotiation and accountability, we have a clear approach to the scrutiny of providers, and rightly so. That applies to all Departments, and the same applies when it comes to failure. The contract has an open-book accounting approach and a robust validation of data. I think the hon. Lady mentioned falsification of data at one point. We have a clear process on the validation of data. She also went on to comment on how providers are incentivised, but our providers are not incentivised by benefits outcomes. We have a full range of balanced performance measures that focus on quality and volumes and customer satisfaction. That brings me back to the fact that we are speaking about people and how the interaction with people through assessments actually takes place.

Performance reviews and performance are fundamental in all Government contracts to ensure governance arrangements, and the Department takes steps to implement regular weekly and daily meetings with DWP officials and the CHDA.

--- Later in debate ---

[Louise Haigh]

I thank the Minister for that, if I may say so, uncharacteristically measured and conciliatory response. It is fantastic to hear that we agree on so many matters, and that the Government recognise the issues with the work capability assessment. We disagree, however, about the reliability of assessments. The evidence, not least the huge increase in successful appeals over the past couple of years, shows that reliability has not improved.

The Minister referred to the recommendations that have been implemented, and my hon. Friend the Member for Bermondsey and Old Southwark (Neil Coyle) asked about those that have not been applied. It is important that assessments are documented so that records can be used as proof afterwards, because, as I mentioned earlier, there have been allegations of falsification.

On the Minister’s remarks about the previous performance of Maximus, as a shadow Cabinet Office Minister I can tell her that the guidelines for considering past performance are completely unsatisfactory. It is no surprise to me that a contractor with prior performance as appalling as that of Maximus, which has failed so singularly in the past, has been awarded a contract. We welcome the improved targets and oversight, but transparency on whether Maximus has met its targets, on spending and on WCA appeals is vital to hold the contractor to account.

As my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) said, the cuts are completely unjustified before the changes that the Minister outlined come into force. I hope the Government will rethink them in the Bill that the House of Lords is considering today.

I look forward to the response to my points and those of my hon. Friends, to the publication of the White Paper and to the much-needed long-term reforms, learning from the mistakes made by successive Governments in the management of the work capability assessment.

Question put and agreed to.

Resolved,

That this House has considered work capability assessments.