Work Capability Assessments

Neil Coyle Excerpts

Tuesday 9th February 2016 Westminster Hall

[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.

[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.

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[Gerald Jones]

My hon. Friend illustrates a valid point that is replicated across the country.

I am sure that hon. Members are as concerned as I am when they hear that, according to the DWP’s own figures, around 50% of assessments are overturned on appeal. That surely calls into question the reliability of the initial assessments and raises the question why we are putting people through such unnecessary stress, which has undoubtedly had a negative impact on the mental health of many claimants.

I am also concerned that the work capability assessments do not seem to take account of individuals who have a limiting long-term illness that means their condition often fluctuates, such as kidney dialysis patients or people with Parkinson’s. I visited the kidney dialysis patients support group in Merthyr Tydfil last weekend, and a number of people told me of their concerns about the work capability assessment and the lack of understanding of their condition. Dialysis patients often feel reasonably all right on certain days between dialysis, but on the day following treatment they can feel very low, which means that if they are receiving treatment three days a week, the number of days when they feel okay are few and far between. The Government need to address that lack of understanding.

If the original clauses 13 and 14 of the Welfare Reform and Work Bill are reinserted, financial support for new claimants in the work-related activity group will be cut by around 25% from £102 to £73, which will have a drastic impact on disabled people. The Government have said that they are committed to protecting support for disabled people, so the clauses are deeply worrying. The cut will not incentivise people, as the Government say they want.

[Neil Coyle]

Could the Government’s proposed cut to half a million people, including people with learning disabilities or cancer, have the perverse incentive that those people will then try to go into the support group when there is already a 280,000 backlog due to the Government’s incompetence in handling that contract?

[Gerald Jones]

I agree, and it shows how ill thought out the Government’s proposals are.

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[Patricia Gibson]

I am afraid the only possible reason I can think of for that is that the information does not present the work capability assessments in a flattering light. I leave others to draw their own conclusions about how bad it might be.

The worst thing about the system is that those caught up in the controversy and confusion are people with long-term health conditions, and some of the most vulnerable people in our communities. There is a lot of consensus in the Chamber about the need for an urgent review of the work capability assessment. As the hon. Member for Sheffield, Heeley (Louise Haigh) pointed out, the cost is increasing, and it is expected that £595 million will be paid for 3.4 million assessments—about £190 per assessment. There has also been a problem with the recruitment of enough medical professionals to meet the demands of the assessments. At least £76 million of taxpayers’ money has been wasted through the failure to get a new IT system up and running more than two years after it was supposed to be in place. As has been mentioned, the National Audit Office report, which was released only last month, revealed that

“recent performance shows the Department has not tackled—and may even have exacerbated—some of these problems when setting up recent contracts”.

[Neil Coyle]

The points about rising costs and the backlog are well made. Perhaps we can help the Minister by asking her to consider removing some of the routine retests for those with progressive conditions and conditions that will not change. We have all had the excellent briefings from Parkinson’s UK and Mencap, for example. Perhaps the Minister should look again at the frequency of testing for some people, to save the taxpayer money and save some of the stress and anxiety that the hon. Lady has mentioned.

[Patricia Gibson]

That is an excellent, well made point and I thank the hon. Gentleman.

There is also a problem with transparency. In December, the Work and Pensions Committee concluded that it was unable to scrutinise benefit delays fully because of lack of available data. Its report said that

“if the DWP has this data, they should publish them. If they do not, then they are making policy decisions in the dark. The Department should address the lack of data immediately.”

Chillingly, in answer to parliamentary questions about the connection between assessment tests and the incidence of suicide or mental health problems in disability claimants, the Department has admitted that it neither holds such information nor has any plans to collect it. I think that is significant. There has also been an admission that it does not have information on how much, on average, it costs the Department to fund an appeal against a fit for work decision. It is clear—and becoming increasingly clear to claimants—that the system is in a mess. There is clear capacity shortage; there are also wildly optimistic targets, a lack of transparency and problems with hiring and training staff—within the context of dealing with individuals with long-term and serious health problems who are simply trying to access the support they need to survive. The National Audit Office has concluded that this system has

“significant financial and human costs”.

The current situation is cruel, inhumane and demeaning; as has repeatedly been pointed out in the debate, the system is not fit for purpose. I sincerely hope that the Minister will respond to the debate in a positive way and consider the significant financial and human costs to those who need, rather than bureaucracy and judgment, our support and compassion. The debate is about much more than simple work capability assessments. Ultimately, it is about the kind of society we want to create, and the society we aspire to be.

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[Dr Whiteford]

As ever, the hon. Gentleman makes an important point clearly. There is no reason why people’s medical history should not be included in the assessments. Often, consultants—sometimes it is a GP, but in cases of serious illness it is more likely to be a consultant—are in a position to provide insight into the longevity of a condition as well as its immediate acute effects.

[Neil Coyle]

Is the hon. Lady aware that the Government, during the last Parliament, also shortened the timeframe within which individuals can provide independent medical evidence? As it takes longer to see a consultant or specialist, that inevitably means that some people cannot provide that information in time, which contributes to the number of reassessments, the backlog and the cost to the taxpayer.

[Dr Whiteford]

The hon. Gentleman is absolutely right. The shortening of the timeframe makes it extremely difficult for people to contribute, which is why that opportunity needs to be included right at the start. If people can nominate someone—an advocate, a consultant, a GP or a community nurse—to provide such information as part of the application process, we could get around a lot of those problems.

For people with complex disabilities, people who suffer from more than one condition or people whose condition fluctuates, the tick-box exercise of the work capability assessment fails to capture the impact of their health on their ability to work. Around half of those in receipt of employment and support allowance have a mental health condition, yet the work capability assessment has proved poor at accurately assessing conditions that are not visible, and people with mental health or incapacity issues are not always able to articulate well the effects of their condition.

I pressed hard during the last Parliament for improvements to how mental function champions operate within the assessment process, but there is increasing evidence that as things stand, the work capability assessment causes so much distress and anxiety for some people that it is actively harming their health, pushing them further away from being able to work and—in extreme cases such as the ones mentioned by the hon. Member for Glasgow East—towards harming themselves.

The Royal College of Psychiatrists has expressed serious concerns for some years about the impact of the work capability assessment on the health of people with mental illness, but as evidence of harm grows, the college is becoming more outspoken. As my hon. Friend the Member for North Ayrshire and Arran pointed out, robust research conducted at the universities of Liverpool and Oxford suggests a correlation between mental health problems and the roll-out of work capability assessments. That backs up the findings of voluntary sector service providers such as the Scottish Association for Mental Health, which has extensive experience of people who use its services suffering setbacks in their recovery due to the assessment process.

The bottom line is that too many people are still being wrongly assessed. We know that because of the extraordinary success rate when claimants who have been found fit for work appeal that decision. Between 2010 and 2013, it hovered around the 40% mark; since the introduction of mandatory reconsideration in 2013, it has shot up to around 54%. In other words, more than half of those who appeal are likely to get the original decision overturned. Successful appeals on that scale indicate major underlying flaws in the assessment process, and they cost the Government a lot of needless time and money. More than that, they mean that sick and disabled people are left feeling abandoned and desperate for months without the support that they need. The human cost is enormous, as is the financial cost, as the National Audit Office has pointed out.

We must also remember those who do not appeal but who are nevertheless extremely unwell or seriously disabled. Many people in our constituencies who are destitute or living in extreme poverty are people whose access to ESA has expired, or who have been found fit for work but cannot qualify for jobseeker’s allowance—because they really are not fit for work and cannot comply with the conditions attached to JSA, or because they have tried to comply but have been sanctioned, or because they have disengaged from the system altogether and have simply dropped out of view.

I have no idea how many people fall into that latter category, but I know that I am meeting such people regularly. They live off other family members or friends, some of whom are themselves not wealthy, and they depend on food parcels from church voluntary groups or food banks. Consequently, when the Government consider how they might proceed with a replacement for the WCA, they need to take on board the systemic failures of the current approach and think beyond simplistic functionality.

The first and probably the most valuable thing that the Government could do is to work with disabled people and their representatives from the outset. Throughout the past few years, health and disability organisations have been coming forward with constructive suggestions to improve the existing system, and contributing to the successive reviews. Some of their ideas have been taken on board, at least partially, but the opportunity presented by a new White Paper to get stakeholders around the table and—more significantly—really listen to what they say has never been more important.

I also urge the Government to go back to the work that was done around the evidence-based review of 2012-13 and the alternative assessment that was developed under that process. I know that Ministers were not convinced by that review at the time, but a lot of water has flowed under the bridge since then, a much stronger evidence base has been developed and I think there is a lot of substance in that review, not least in the way that it suggests descriptors that would account for the impact of pain and fatigue on a person with an illness or a long-term condition. That review could really usefully inform a new approach.

Lastly, I urge the Government to learn from international experiences. The UK does not have a disproportionately high number of sick and disabled people compared with the rest of the OECD. Clearly, there are regional variations, even within the UK, with higher numbers of claimants in economically deprived or heavily industrialised areas, where health outcomes and life expectancy are significantly lower than average. On the whole, however, we are grappling with the same challenges as other industrialised countries and on a broadly similar scale.

A number of countries have used what have been called “real world incapacity assessments” that take account of a person’s age, skills and work experience, as well as their health or disability, when assessing their fitness for work and considering what kind of work they might be able to do. This seems just to be common sense and means that someone is assessed as a rounded human being. The same condition with the same severity will affect two people differently in relation to their ability to work, depending on whether their work experience has been in physically demanding manual jobs, whether they sit at a desk or whatever. The Government should explore the models used in other countries to see what is working well.

We all agree with the Government that the social security system needs to support people to move towards work, but it also needs to provide a safety net and a dignified life for those who are not fit for work, and not only those who will never return to work but those with long-term conditions and those who need time to recover from serious illness or injury.

The work capability assessment has failed a lot of sick and disabled people, and it has proved extremely inefficient. What follows must be better, and I hope that the Government’s keenly anticipated White Paper will reflect the concerns that have been raised today.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

May I reiterate what other people have commented—that it is lovely to see you in the Chair today, Mrs Moon? I congratulate my hon. Friend the Member for Sheffield, Heeley (Louise Haigh) not only on securing this debate but on an excellent speech; it really was very informative.

We have already heard a number of Members say that the current work capability assessment, which was introduced under the coalition Government, is failing on a number of counts and needs to be overhauled. I share the view of the hon. Member for Banff and Buchan (Dr Whiteford) that the fact no Government Members have spoken, and the imminent White Paper, suggest that the Government are finally getting it. I really hope that is the case. However, I need to reiterate some of the points that have been made about why the Government need to think again.

The WCA needs a complete overhaul. It is not fit for purpose, and we have heard that it is failing to assess a person’s fitness for work, or work-related activity, accurately or reliably. We have heard the figures about appeals. More than half of people—54%—who appeal against a decision that they are fit to work have the decision overturned. We have also heard about how the costs of the WCA have spiralled out of control, which reflects the woeful performance. Obviously, the National Audit Office report last month was very damning indeed, although I have to say that it came several weeks after it was clear what was going to happen.

Fundamentally, the WCA fails the most important requirement of any Government policy—that it will not knowingly harm citizens. For almost a year now, the Government have obfuscated and tried to evade revealing the toll that the WCA process is having on the people being subjected to it, even after stark warnings from the Select Committee on Work and Pensions. The mounting evidence against the WCA cannot be ignored any longer; hopefully the Government are listening to it.

There have been five independent reviews of the WCA since 2010. The Work and Pensions Committee undertook two of them in the last Parliament; I was pleased to be serving on the Committee when it undertook the review in 2014. The most recent report from that Committee included evidence taken from the reviewers, who warned the Government that in spite of all the reviews that had happened before—Professor Harrington and Dr Litchfield have produced reviews—the process was still flawed. They said that people with progressive and fluctuating conditions, such as Parkinson’s, were particularly likely to fall foul of the process. I will never forget taking evidence from people in Newcastle as part of that Select Committee inquiry in 2014 and hearing their personal testimonies. The evident pain and humiliation that they had experienced as part of the process was quite shocking.

Like other hon. Members we have heard from today, I have had evidence from my own constituents. A man who came to see me had a serious heart condition. In a WCA, he was told by the nurse undertaking it that he was in the process of having a heart attack; that was how stressful the WCA was. He was told to go to hospital, but two weeks later he received a letter telling him that he had been sanctioned because he had left the WCA. There are similar examples up and down the country.

The former chair of the Work and Pensions Committee, Dame Anne Begg, spoke on the issue and said:

“When my constituent, who has lost his job because he has motor neurone disease, scores zero on his WCA and is found fully fit for work, there is something wrong with the system. When that same constituent appears in front of a tribunal and in less than five minutes is awarded 15 points”—

that is the maximum score, which means the person is completely unfit for work—

“there is something wrong”.

I hope that we are seeing a different view from the Government now, but in their response to the Work and Pensions Committee at the end of 2014 they were having none of its report; there was the usual rhetoric. I would be interested to know what the Minister would say today if Dame Anne’s former constituent was standing here in Parliament now.

The Committee said that simply rebranding the WCA by taking on a new provider would not work, and it recommended a complete overhaul of the system. We still believe that that is needed, and such an overhaul is Labour party policy; I have said that consistently since my appointment to the Front Bench. What is required is not just a process to determine eligibility for employment and support allowance but an examination of health-related barriers to work. I agree with the hon. Member for Banff and Buchan that we need to look at the international data. I know that work has already been done to compare different processes, and adopting a more personalised and holistic approach is important. I remember producing such a piece of work before I came to the House, and there are lessons to be learned from elsewhere. However, as I have said, at the time of the Select Committee inquiry, the Department for Work and Pensions was not particularly inclined to consider those lessons.

When the Minister responds to the debate today, I am sure she will talk about the new work and health unit. However, I would also like her to describe, if she can, the discussions that the Government have had with the royal colleges, because I have some concerns. For example, the Royal College of Psychiatrists has raised the issues of medical ethics, treatments and interventions, the principle of consent, and the qualifications of the staff involved in WCAs. I would be grateful if she referred to those points in her wind-up.

My next point is about poor performance. We know that last month’s National Audit Office report reiterated that the WCA is not only unfit for purpose but poor value for money, as many of my hon. Friends have already mentioned. The Government have failed in their fiduciary responsibility to ensure that taxpayers’ money is spent wisely. They have failed to monitor and performance-manage work capability assessment contracts and hold the providers to account.

The NAO report stated that under contract with the Centre for Health and Disability Assessments, which is a subsidiary of Maximus, the cost of each assessment has risen to approximately £190, compared with £115 under the previous contract with Atos. If that was an investment in greater efficiency and a smoother process, one might possibly say that it was value for money, but the NAO described the performance output issues, with a backlog of 280,000 assessments and the contractor not being expected to meet its performance targets for last year.

The NAO went on to describe how the Department for Work and Pensions was struggling with target setting and had failed to test bidders’ assumptions during the tender process—for example, on staff recruitment and training. Will the Minister describes how that is being addressed? After six years, it is a real problem if we are trying to ensure that we live within our means.

The biggest indictment of the Government’s work capability assessment process is the potential harm it does to people who are put through it. As we have heard, last November the University of Liverpool and the University of Oxford published a study in the Journal of Epidemiology & Community Health. It is a peer-reviewed journal, and papers with Mickey Mouse statistics are not published in such journals—they would not be tolerated. It is a robust—[Interruption.] I hear some chuntering from the Government Benches. These are robust data; papers would not be allowed if the data were not robust—[Interruption.] There is still chuntering, but I will carry on. That study showed that between 2010 and 2013 the Government’s work capability assessment regime was independently associated with an additional 590 suicides, 280,000 cases of self-reported mental health issues and 725,000 antidepressant prescriptions.

The Royal College of Psychiatrists has raised the concern that, for people with mental health conditions, the work capability assessment process can cause a relapse, thus hindering rather than helping in their recovery. Just before I came to the debate I was provided with a list of coroners’ reports containing concerns that the deaths, including suicides, were associated with the work capability assessment. I am particularly concerned about the case of Stephen Carre, which has already been mentioned, in which the coroner wrote to Ministers and the Department and apparently did not receive a response, as required by law. I would be grateful for the Minister’s response to that point.

The findings reported in the paper in the Journal of Epidemiology & Community Health—in a paper entitled “First, do no harm”—came on top of published data relating to the deaths of incapacity benefit and ESA claimants between November 2011 and May 2014. The Government were compelled by the Information Commissioner to publish those figures. At the end of April, an appeal went to that body, which ruled in favour of the appellant and required the Government to produce the figures. But when did they produce them? Just before the end-of-August bank holiday.

The figures showed that the overall death rate for people on IB or ESA was 4.3 times higher than in the general population—an increase from 3.6 times higher in 2003. People in the support group are 6.3 times more likely to die than the general population, and people in the work-related activity group, from whom the Government want to take £30 more a week via the Welfare Reform and Work Bill, which is going through the House, are 2.2 times more likely to die.

The Government’s innuendo that people with a disability or illness might be “faking it” or are “feckless” or, as the Prime Minister said shockingly last week, are “making a lifestyle choice”, is grotesque and belies the epidemiological data. IB and ESA are recognised as good population health indicators, in that they reflect areas with an industrial backgrounds and areas of poor health.

[Neil Coyle]

My hon. Friend describes the impact on people. One of my constituents has referred to it as the Secretary of State adopting a pterodactyl style of management, flapping around high above, making a lot of noise and—pardon the expression—dumping on the little people down below. Does my hon. Friend share that view?

[Debbie Abrahams]

I would not put it in quite those words, perhaps, but I know exactly what my hon. Friend is getting at.

The Government’s own data show that the people involved are sick and disabled. They need support; they do not need vilification. Unfortunately, that is too often what happens, as at last week’s Prime Minister’s questions.

Being disabled or being ill is not a lifestyle choice. Alarmingly, we now hear reports of people in the ESA support group—people who have been found not fit for work, including people who are terminally ill—being required to go to work-focused interviews. The Minister might be aware of that. We have evidence only from England so far, but I would be grateful if she gave us an explanation.

For me, that latest revelation says it all. It is about cuts for disabled people and the seriously ill. The Government are not content with having cut £23.8 billion from 3.7 million disabled people since 2013 under the Welfare Reform Act 2012; they are going for more cuts, and the work capability assessment and the Welfare Reform and Work Bill are another way of achieving them.

The Government have tried to regenerate the economy on the backs of the poor and disabled. Their modus operandi is division and blame, deserving and undeserving. Like the NHS, our social security system is based on principles of inclusion, support and security for all, assuring us all our dignity and the basics of life should any one of us become ill and disabled. The Government need to remember that and stop their attacks on disabled people.

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[The Minister for Employment (Priti Patel)]

It is a pleasure to serve under your chairmanship, Mrs Moon. I start my remarks by commenting that the debate has been wide-ranging, and I thank everyone who has contributed. This is obviously an important subject, and we must put it in the context of the overall commitment we all feel should rightly be in place to support people who cannot work because of health conditions and disabilities. We must also reflect on the fact that we have a system that obviously seeks to support such individuals.

A range of comments have been made that pre-date me as a Department for Work and Pensions Minister. I will do my utmost to address as many of them as I can, but it would only be fair to write to hon. Members whose points I do not address directly. The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) mentioned the very tragic case of Mr Carre, and it might be more appropriate if I write to her about that.

We all recognise that work is good for individuals—it enhances physical and mental well being—and we also recognise that being out of work, for whatever reason and whatever the condition, can exacerbate poor health conditions and make people’s situations even worse. A system that supports people is vital. I will talk about contracting later, but we want to move away from a system that tells people they cannot do any work to one that supports them in what they can do. The hon. Member for Banff and Buchan (Dr Whiteford) touched on the forthcoming White Paper that will focus on the support that can be given to individuals, and I will address that shortly.

The work capability assessment was established under the previous Labour Government in 2008 and it has had quite a journey, not just in relation to the contracting process; the assessments have come under scrutiny under previous Governments and under the present Government. There have been more than 100 recommendations in response to the five independent reviews of the work capability assessment. That has made the assessment process more reliable and has improved the claimant experience

In the final independent review of the work capability assessment, Dr Litchfield commented that, having looked at the systems in comparable countries, there was

“no better replacement that can be pulled off the shelf”.

[Neil Coyle]

There is a concern among the disability and advice sector that the Government continue to say they have accepted the recommendations of the independent reviews. Will the Minister outline how many of the recommendations have been fully implemented?