Mental Health: Assessment

Sarah Newton Excerpts

Tuesday 22nd January 2019 Westminster Hall

[The Minister for Disabled People, Health and Work (Sarah Newton)]

It is a pleasure to serve under your chairmanship, Ms Ryan.

I begin by my adding my praise to that of other Members for the hon. Member for Lanark and Hamilton East (Angela Crawley), both for securing this debate and for the way in which she addressed the House. She and others are absolutely right: I am utterly determined to make sure that we improve the system by which we assess people for employment and support allowance, the personal independence payment and of course universal credit. I am just as ambitious as everybody else in the room to ensure that we treat everyone in society with respect and dignity, and really promote their human rights.

On independent assessments, people who go on this journey—I do not want to call them claimants or customers; that was a good point well made by the hon. Lady—through the system give the approach that we have taken to both ESA and PIP a satisfaction rating in the high 80s. That is the vast majority of people applying for these benefits. This is not something we measure internally; it is properly independent research that we publish and is open to scrutiny. One poor experience is one too many. We are utterly determined to improve the experience at every stage of the journey, and really put the person at the centre.

PIP was introduced to ensure that mental and physical health conditions have parity of esteem. Many more people are benefiting from it than ever did from disability living allowance, and are getting the higher rates of support, for both their daily living and their mobility. Broadly, therefore, it is working, but as we have heard, there are some absolutely horrendous and terrible cases of unacceptable behaviour, where things are going wrong. I thank all hon. Members who have come along today. It is clear that everyone here wants to do the best they can for their people and to work with me to absolutely get this right, and I welcome that.

I want to answer questions, but I have been given very little time to respond; that is the nature of these debates. As always, I will write to hon. Members on any questions that I do not have time to address. I start with the invaluable work of the Work and Pensions Committee. It is great to have one of its members here speaking up for that. The Committee gathered a huge amount of evidence, and I looked through all the research findings and the Committee’s recommendations thoroughly. We have agreed to implement all those recommendations, and we are carefully working our way through every single one of them. I want to reassure hon. Members that I work very closely with SSAC. It is an invaluable body. Everyone in the Department always thoroughly considers its reports and recommendations, and whenever possible we seek to implement them.

A few hon. Members mentioned video recording, which, when I came from the Home Office to take up this position, I thought was a really good idea. One of the fundamental problems we face with people claiming benefits is a lack of trust. Unfortunately, too many people are worried. We have today heard eloquent contributions about people being really worried about having to go through the process. In spite of the fact that most people have a really good experience, most of them are worried before they enter the process. I obviously want to eliminate that, as does everyone in the Department.

I want people to fill in the forms confidently, and pick up the phone or go into their jobcentre thinking, “There will be compassionate people who will help me”. That is what we are all striving to achieve. I believe that video recording the assessments will play an incredibly important role in regaining people’s trust in the whole process. Hon. Members will know that audio recordings are already available, but they are not done with the most up-to-date equipment. It can be a clunky and difficult experience, and I want to make it as easy as possible.

Throughout the summer we did a lot of work both with people who are claiming benefits and with healthcare professionals. All assessments are undertaken by fully qualified healthcare professionals. They are mostly nurses, but they all have experience and they have additional training in how to undertake the functional assessments. They are highly motivated and trained individuals, and it was important to consider how they felt about the video recording, just as much as how people coming in to be assessed felt about it. Having taken all that into consideration, we have started a pilot, which is going well. It is voluntary, because we wanted to ensure that people felt really confident about having their assessments videoed.

The strength of the pilot will be that lots of people take up the opportunity. There is no point coming up with a videoing possibility if people are not prepared to say, “Yes, I would like my assessment to be videoed”. We have been working carefully on the pilot and will review the findings to see how and when we can roll the initiative out. There is an absolute determination and commitment to doing that, because it will build the trust and confidence in the system that we want.

We have also been looking at every single stage of the process. I really want to assure hon. Members that I regularly meet our stakeholders—the large charities and disability rights organisations. We have a PIP forum and a stakeholder team working with us on improvements to the work capability assessment, and disabled people are really getting alongside us and working with us on improving the process. I have already commissioned an independent review of the PIP application process. We have been looking carefully and in detail at every single part of the claimant journey—the person’s journey—through the system to see what more we can do, right through to how we can improve our mandatory reconsideration process. At the same time, as I said, we have been implementing the very helpful findings of the Work and Pensions Committee.

Going back to comments about what happens in the assessment, we will make a decision based just on the application, without sending someone to a face-to-face assessment, if we can gather enough information from the person applying for the benefit, and if they provide information from healthcare professionals, whether they be consultants, GPs or community mental health nurses. We will use that information whenever possible. A lot of our work over the summer was engaging with healthcare professionals to try to understand the barriers to their providing us with information. Relatively small numbers of people go to appeal, and relatively small numbers have decisions overturned. Most often, decisions are overturned because more information has become available by the time of the appeal. I am determined to see what we can do to have the information provided up front by healthcare professionals, so that we can make more paper-based assessments, without the need for face-to-face ones.

Hon. Members will know that we have introduced a set of new criteria called the severe conditions criteria, for employment and support allowance and now for PIP. If people have severe mental or physical health conditions that, sadly, are not going to improve, we put them into a category where they do not have to be reassessed, apart from a very light-touch reassessment after 10 years, just to ensure that their circumstances have not changed. That means that fewer people will be reassessed, and I hope that everyone here can commend that.

On some of the other observations on face-to-face assessments, we have had quite a discussion about the mental health questions. The questions that the assessors use and the training they receive is all approved by the National Institute for Health and Care Excellence. I think hon. Members were referring to the mental state examination questions. As my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who has left the room and is a doctor, said, this is the best practice of the medical profession. It is really important that the Department takes its duty of care very seriously—and we do. Right through from our job coaches in Jobcentres Plus to people in our telephony services, we have a really good process to ensure that anyone expressing suicidal thoughts is supported. For example, everyone in our jobcentres is going through mental health training to ensure that they feel able to chat to someone with suicidal ideation and keep them safe and in front of them while their colleagues secure additional support from the NHS. We take that extremely seriously and are led by the best evidence—

[Debbie Abrahams]

Will the Minister give way?

[Sarah Newton]

I have so few minutes and so many questions to answer.

I want to reassure hon. Members that our work in this area is led by the best possible clinical input. The deputy chief medical officer, Professor Doctor Gina Radford, oversees all this work, because keeping people safe is just as important as treating everyone with respect and dignity and ensuring that their human rights are upheld.

I will conclude, so that I can give the hon. Member for Lanark and Hamilton East a few moments to wind up. I am absolutely determined to carry on our work on fibromyalgia and on all the issues she has mentioned. I have invited people into the Department for weekly meetings, so that together we can make the changes we want to see.