Atos Work Capability Assessments

Meg Hillier Excerpts

Thursday 17th January 2013 Commons Chamber

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

I offer my hearty congratulations to the right hon. Member for Oldham West and Royton (Mr Meacher). He has long been known as a champion in this area. I listened carefully to what he had to say and I am afraid that my experience, and that of the people I have been talking to, mirrors much of what he is saying.

I would like to address the debate from the perspective of people with autism. There is a great deal of concern on both sides of the House, and among our constituents, about the way this process handles people with autism. The National Autistic Society, which provides advice to so many of us in this House and on which we rely a great deal, believes that the work capability assessment should be delivered differently so that it is fair and appropriate for claimants with autism.

More than 2,000 people have signed a National Autistic Society petition to Atos, which was launched following the “Dispatches” and “Panorama” investigations, with which many of us are familiar, into the company last year. The programme claimed that Atos was working to internal targets on the numbers of people being put into the work-related activity group, the support group or as being fit for work. Atos has indicated that it is open to working with the National Autistic Society and other charities, including in the context of this petition, but I have a specific question for the Minister. Will the Minister provide assurances that no such targets are in place?

There have been key concerns with the face-to-face assessment process. The work capability assessment model can certainly prove to be challenging in the context of claimants with autism. Most people with autism have difficulties with social interaction, and some will also lack insight into their difficulties. They may also have difficulty understanding the questions being asked and with communicating a response. Even travelling to the assessment centre and engaging with the process may be difficult to understand and create great anxiety. Therefore, face-to-face assessments may not always result in a fair and accurate assessment of claimants’ ability to work. The NAS has had a lot of inquiries relating to the quality and appropriateness of the WCA for claimants with autism, and that feeds into a broader picture of widespread concern.

There is also concern about the awareness of, and training for, assessors. In the cases of claimants with autism, including high-functioning autism and Asperger’s syndrome, difficulties in the workplace may not be obvious and may not become apparent in the course of a face-to-face assessment. That could be due to the hidden nature of the disability and a desire to appear more able than they really are to an assessor, or to other difficulties with this form of communication associated with the condition. It is therefore a strongly held view that it is vital that claimants with autism are assessed by professionals who have received autism-specific training. That would ensure that assessors have a better understanding of autism and routinely make reasonable adjustments as part of their assessment.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

Will the right hon. Lady give way?

[Mrs Gillan]

If the hon. Lady will forgive me, I have only a short time to speak.

I think people are pleased that the Government have committed to having mental and cognitive champions, but I believe that people are concerned at the number of champions, their level of training and their expertise in autism. Our understanding is that there about 60 across the UK and it remains unclear what, if any, expertise they have in autism.

On collecting evidence, the NAS has consistently called for a tiered approach to assessment, both in terms of the WCA and the assessment process, for the personal independence payment under the new benefits system. I hope that the Minister, who has met recently with the NAS, Mind and other organisations, has listened carefully, and I am looking for reassurance in his response that all these points will be taken onboard.

In summary, I have a few questions for the Minister. What steps will the Government take to ensure that Atos collects existing evidence relating to a claimant’s capability to work, which would create a more cost-effective and streamlined system? Do WCA assessors receive autism-specific training? If so, of what does it consist? How many of the mental and cognitive champions currently operating at Atos assessment centres have specific autism training? How will he monitor the effectiveness of the introduction of those mental and cognitive champions?

I am sorry I could not give way to the hon. Member for Hackney South and Shoreditch (Meg Hillier), because I know she has a great track record and a special interest in this matter, but I hope that she will make her own speech. I hope that I have reflected in my contribution the widely held concern about this process among those least able to speak for themselves, and I hope that the Minister will respond positively.

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[Mrs Madeleine Moon (Bridgend) (Lab)]

My caseworker, like those of many Members, is inundated with cases that are tragic and heart-rending. The telephone line to my office is often clogged with crying people. They often ring several times a day, as they are unable to cope with the stress that they are facing. Many have mental health problems, and are unable to cope with the paperwork. They are unsure what to do with it, and they ring me to ask for help in the most tragic and personal way.

[Meg Hillier]

My hon. Friend raises the issue of people with mental health problems. Does she agree that that is an area of great concern, along with other conditions that can fluctuate, such as HIV and AIDS? Such conditions are difficult to assess in a 15-minute interview. Does she also agree that it is the framework of the assessment that is at fault, and that Atos might have something to answer for as well?

[Mrs Moon]

It is absolutely clear that the framework of the assessment is unable to clarify realistically whether someone is able to work. The assessment is not valid for the purpose for which it was set up, unless that purpose was deliberately to deny people access to benefits.

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[Valerie Vaz]

I agree with my hon. Friend.

My constituents cannot understand why, although 40% of appeals are upheld, the Minister’s predecessor said that the system works. When I asked him, in a written question, how many people in Walsall South had been declared “not fit to work”, his response was:

“Please note that constituency information on the work capability assessment process is not available.”

It is no wonder that the Government have no idea why my constituents are suffering, but I will tell them now.

SD has cancer and is undergoing radiotherapy; she has been declared fit for work. SH suffered seven strokes, and also suffers from type 2 diabetes and a liver condition; she has had to appeal against a decision. KH was placed in a work-related group; she has incontinence of bowel and bladder as well as diabetes, and is partially sighted. CS has received zero points despite having a spinal disc prolapse. SA suffered a stroke and is blind, but has still been declared fit for work. LM has arthritis of the spine, and has had to appeal against a decision. Stephen Nye was so angry that he came to see me on behalf of his father, and said “I want to let you know what is going on. Sick people are being persecuted: the assessment system is flawed, and they are being harassed by the jobcentre.”

[Meg Hillier]

Does my hon. Friend agree that the tenor of the debate about “strivers and skivers” says a great deal about what the DWP intended when it set up the assessment system—as do my sheaf of papers relating to constituency cases and the list of cases that she is reading out?

[Valerie Vaz]

I entirely agree, and I do not subscribe to the “strivers and shirkers” nomenclature.

MD came to see me with her husband, who is blind and deaf. They told me that the work capability assessment did not take account of the issues faced by blind and partially sighted people. I wrote to the Minister’s predecessor, who replied that Professor Harrington had had considerable engagement with the Royal National Institute of Blind People, Sense, and Action on Hearing Loss. However, that was only at the time of the professor’s third review—it should have happened before the assessments had even been devised—and only at the time of his second review did he suggest the introduction of sensory descriptors and an additional descriptor addressing the impact of generalised pain and/or fatigue.

I am pleased to say that, at their annual conference, GPs called for the scrapping of the computer-based work capability assessment. They should know: they make the medical assessments every day, and they see the sick and the vulnerable every day. There is no common sense in these assessments, and there is no humanity or dignity for the most vulnerable members of society. I urge the Minister to listen to those who have to undergo these assessments, and to instruct Atos to start again.

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[Bob Blackman]

I agree. One reform we could quite reasonably ask the Minister and Atos to introduce would involve ensuring that the assessor was qualified to assess the type of problem from which the individual suffers. That could take the form of a referral by the Atos assessor to a proper medical professional in a given field where there was expertise. That would save the individuals from the trauma of the appeals process and would save money as it would mean that the medical professionals could properly undertake an appropriate assessment. I urge the Minister to consider that as a way of improving the system.

It appears to me that there is a tick-box mentality among the Atos assessors. I could refer to a stream of cases in which people have conditions that come and go and have good days and bad days. When Atos assessors make the assessments, those people can often be having a good day and the tick boxes do not allow the right decision to be made.

[Meg Hillier]

Will the hon. Gentleman give way?

[Bob Blackman]

I will not, because I have given way twice and I want to conclude.

The clear point is that there needs to be a fundamental reform of the process. It is right that we should assess people to see whether they are capable of work, but the people subjected to horrendous trials and tribulations as a result need further support and deserve to have the whole process reconsidered so that it can be improved for the benefit of all.

[Austin Mitchell (Great Grimsby) (Lab)]

The number of MPs who want to speak today and the passion that has been shown are testimony to the fact that the system has not worked, is not working and ought to be scrapped. I hope that the Minister is listening, because that is clearly a strong concern on both sides of the House.

The key weakness of the system is the perfunctory, mechanical, inhuman and rushed process of assessment. I have to point out to the Minister that as the system has been handed to the private sector, the more perfunctory the process of assessment, the greater the profit made by Atos and the assessors.

[Meg Hillier]

Other Members have raised the issue that Atos is a private company. I am sure that my hon. Friend will agree that it would be helpful if the Minister could reveal the profit margin, as this is public money being spent by a private company, which one would expect to make a profit. Would it not also be useful if the Minister could tell us whether there has been any change in the profit in the years for which Atos has been doing the assessments?

[Austin Mitchell]

I am grateful to my hon. Friend for that intervention. That was one of my concerns as a member of the Public Accounts Committee and it was to have been part of my passionate penultimate ringing declaration when I intended to ask the Government to tell us how much profit has been made, but I can now omit that from my speech.

The system is perfunctory and totally inadequate. I will not repeat the cases that have come to my surgery after the assessment—that has been done brilliantly by some of my colleagues—but it is clear that the assessment fails patients with mental health conditions, particularly schizophrenia, which are very difficult to assess and treat. It fails when conditions are intermittent and emerge one day only to fade away the next. It fails on degenerative conditions, too. The system of assessment does not take into account any of its own inadequacies in those areas.

In the Public Accounts Committee, I was able to voice a suspicion that there was a quota for the number of disabled people that should be shaken out in what appears to be an enormous attempt to do that rather than to provide them with the support and help that they need and with encouragement to go back to work. The process is more concerned with shaking them off benefit than with treating their cases properly. We were assured by Atos and the Department that there was no quota, but I think we can guarantee that any medical assessor for Atos who finds that the total or a high proportion of the number of people he is examining are not fit for work will not advance his career in assessment, his career in Atos or his contact with the Department. Inevitably, there are those pressures on the assessors.

As our Committee was told, 38% of the cases that go to appeal—I advise all my cases to go to appeal—are successful in reversing the verdict. That demonstrates its inadequacy and the enormous cost in the reassessment process at appeal, a cost that is not taken into account in the Government’s estimates of the savings produced by the system. Those reassessments are usually done with the help of the patient’s own doctor, so I do not see why their doctor’s view cannot be invoked and used at an earlier stage in the process. After all, the Government are giving more power to the doctors and claiming that they represent the patients. The doctors know the long-term conditions—they are treating the patient—so why are their views not taken into account by Atos at the start?

Our PAC report on the system was pretty damning—one of the most damning we have done. Our concerns included the rate of profit, as my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) has mentioned. The Minister should tell us the rate of profit made by Atos and what efforts the Department is making to reduce that and to ensure a more efficient service and more efficient assessment processes. We were concerned, too, that this is a monopoly contract with no great risk to Atos. The monopoly is continuously reinstated and Atos is put back in power. Monopoly processes go slack, and if such tasks are going to go to the private sector—I do not think that they should—the companies should be subject to competition and to more regular reviews. The weakness of the assessment system shows that Atos is not working effectively. There should not be a long-term monopoly in this area.

If the Minister reads Twitter at all, as I do avidly—normally to see people abuse me—he will see the widespread concerns about people’s treatment by Atos. If he listens to this debate, he will hear the same. If he listens to the disablement groups, he will hear the same. Instead of backing an inhumane system and refusing to change it or tighten the terms and conditions under which Atos operates, it is time that the Minister showed some concern and changed the system.

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[Guto Bebb]

The hon. Lady’s point is important, because although we all subscribe to the principle of a review, when a condition has been assessed as demanding unconditional long-term support there is a question about whether an annual review is justified. That is an issue that a constituency MP who takes case work seriously would not ignore, so I take her point on board.

There are a couple of aspects that I welcome, but about which I still have concerns. One is the way in which the system deals with patients who suffer from mental health problems. Mental health services are often the Cinderella service of the NHS, but when it comes to people who have difficulty accessing work and feeling confident to do so, the way that Atos deals with such patients has been less than acceptable. I understand that the Department and Atos are putting in 60 champions, but given the number of issues that I have seen in my own constituency, I question whether 60 will be sufficient for the whole of the United Kingdom. The way in which we deal with people with mental health problems is not acceptable in the health service and it is not acceptable at this point in time in Atos, even though the problem has been recognised and work is being done to try to deal with it.

The other matter, which has been touched on by several hon. Members, is the issue of people with chronic long-term illnesses. The problem that I have seen in my constituency surgeries is that quite often somebody may turn up at an assessment centre and on that particular day would be capable of a certain type of work, but the situation could be completely different the following day. The problem with the system that we have put together is that it does not take into account those long-term chronic conditions that could result in somebody occasionally being able to take on work, but not on a long-term basis. That is another weakness in the system.

[Meg Hillier]

Does the hon. Gentleman agree that people with HIV/AIDS, where the side-effects can cause many day-to-day problems, are not properly assessed in the work capability assessment?

[Guto Bebb]

I entirely accept that point. The same is applicable to cancer patients, for example. However, there is a counter-argument that often people who suffer from HIV/AIDS or who are dealing with cancer would enjoy the opportunity of working. My father, who passed away owing to lung cancer, was working until three weeks before he died, and there is no doubt that being able to work for such a long period was a contributory factor to the way in which he fought the disease. We need to make sure that we do not categorise everybody who has a long-term chronic illness as incapable of any type of work.

On a specifically Welsh issue, despite the promises made by Ministers in the Welfare Reform Bill Committee when I tabled an amendment to allow assessments through the medium of Welsh, I have encountered numerous examples where assessments have been requested through the medium of Welsh but that service has not been provided. An excellent example was that of a young woman in my constituency who had a stroke at the age of 42, I believe. As a result, she largely lost the ability to communicate through the medium of English. Despite numerous requests for the service to be provided in accordance with the promises made by the Department, as yet we have not been able to ensure that she has that service through the medium of Welsh, which is her right under the Welsh Language Act 1993.

I subscribe to the general views expressed in the debate that the system is not performing as it should and that there are real concerns about the way that Atos is performing. However, I believe that what the Government are trying to do is right, as it is important that we recognise that we have a higher number of long-term unemployed in the United Kingdom than any comparable western state in Europe, and we need to question why that is so.

I do not think it is necessarily wrong, harsh or unreasonable to say that people who could work should be supported into work, but we need to do that in a way which recognises the dignity of individuals going through the system. Despite my support for the welfare changes that this Government are making, the examples that I have seen in my own constituency surgery leave a lot to be desired. We should not throw out the baby with the bathwater, but we need to make sure that the recommendations that have been made time after time are implemented as soon as possible. We owe that to the constituents we represent.