Atos Healthcare

Stephen Timms Excerpts

Tuesday 4th September 2012 Westminster Hall

[Stephen Timms (East Ham) (Lab)]

I, too, congratulate my hon. Friend the Member for Rutherglen and Hamilton West (Tom Greatrex) on securing this debate about a matter of huge importance to hundreds of thousands of people, as well as on the work that he has done to highlight the problems that people face. I give the Minister my hearty congratulations on his appointment as Secretary of State for Justice and thank him for turning up to discharge his final responsibility in his old job. I am also very pleased that my right hon. Friend the Member for Stirling (Mrs McGuire) is in the Chamber because she and I have had a close interest in this issue for a long time.

The previous Government introduced the work capability assessment and employment and support allowance to provide support for people who are out of work for health reasons, but who are able to plan for a return to work. The current Government chose to take a drastic short cut by curtailing the bedding down period for the new benefit and rolling out the assessment without any improvement, even though by that stage improvements had been identified and proposed. The predictable result of that has been severe problems. Ministers are failing in their task of managing the contract with Atos, of ensuring that people who claim employment and support allowance are treated as they should be, and of reviewing and reforming the test so that it works as it should. The test needs major improvement. Two of Professor Malcolm Harrington’s reviews have reported so far—the hon. Member for Enfield North (Nick de Bois) was right—and while the Government say that they have accepted most of the recommendations, they simply have not implemented them, and that is the heart of the problem.

One simple example that shows the muddle that the Minister has got into has been raised several times in the debate. The year 1 Harrington review recommended that Atos should pilot the audio recording of work capability assessments, and a pilot of 500 claimants followed. Atos said that it was a good idea, but we have heard what has happened in practice from my hon. Friends the Members for Makerfield (Yvonne Fovargue), for Stoke-on-Trent North (Joan Walley) and for Airdrie and Shotts (Pamela Nash).

In a previous debate secured by my hon. Friend the Member for Rutherglen and Hamilton West, the Minister made a commitment that

“we will offer everyone who wants it the opportunity to have their session recorded”.—[Official Report, 1 February 2012; Vol. 539, c. 291WH.]

He has not delivered on that pledge, and it turns out that the problem is a shortage of tape recorders. I was contacted by someone who struggled for weeks to get her assessment recorded. Eventually, Atos wrote to tell her that she could not have a recording or a rescheduled appointment. I wrote to the Minister about that and reminded him of the commitment that he had made. He said that he thought it would be unreasonable to delay the assessment indefinitely for such a reason, but that was not the commitment he gave to the House in February. I am afraid that this mess and shambles shows all we need to know about the Minister’s management of this process. The Government need to get a grip on Atos. I wish the Minister great success in his new job, but I wish he had put a bit more effort into this aspect of his old one.

We have also had a series of mishaps. For example, the Minister made rather farcical efforts to suppress a YouTube video giving advice to people who were claiming against their work capability assessment. It turned out that the subversives who were responsible for this pernicious video were his colleagues at the Ministry of Justice.

Perhaps the most harmful thing to the credibility of the work capability assessment has been the delay in making the changes needed so that the test can work. Professor Harrington’s first review in 2010 asked Mind, Mencap and the National Autistic Society to propose better descriptors for people with mental health conditions. They produced recommendations in November 2010, and Professor Harrington commended them to the Department in April 2011. Further recommendations went to the Department in November 2011 about changes to the descriptors for fluctuating conditions.

[Mr Kevan Jones (North Durham) (Lab)]

Several announcements that have been made, including about having mental health champions, have not been rolled out to assessment centres. Atos is still being inconsistent about allowing support workers or friends to assist those with mental health illnesses who are going to assessments.

[Stephen Timms]

I agree that commitments have not been delivered, and my hon. Friend cites a good example.

The work capability assessment must not be a snapshot of someone’s condition on the day they attend the medical assessment. By definition, that is likely to be a good day, because otherwise they would not be able to show up. The assessment needs to take account of the frequency with which they can do work-related tasks and that with which they suffer the ill effects of their condition. The alternative descriptors proposed do just that. They are now in the public domain thanks to the Grass Roots disability blog, without which we would not have known what they were, and they look like a real step in the right direction.

The Department has had the recommendations on mental health descriptors for 17 months and those on fluctuating conditions descriptors for nine months, but hardly any progress has been made in that time. On 25 June, in a written answer, the Minister said that

“we have been carefully considering how to build an appropriate evidence base around the proposed new descriptors…Terms of reference have been agreed and we aim to publish a report of the Evidence Based Review in the spring of 2013.”—[Official Report, 25 June 2012; Vol. 19, c. 54W.]

The Minister’s successor will need to get a grip on this. If that ambiguous deadline is even met—and that would be a first—it will be two years after expert guidance was received on how to improve the assessment for people with mental health conditions, and a year following the other recommendations.

[Ann McKechin]

Does my right hon. Friend agree that if a person suffers from cancer but does not require chemotherapy, they should still be deemed to be not capable of working if they are in treatment? Why have the Government not changed that indicator when they could do so immediately?

[Stephen Timms]

My hon. Friend raises a good point that we discussed when we considered the Welfare Reform Act 2012. My understanding was that the Government had committed to make precisely that change, but it appears that that has not happened.

I want to ask the Minister two questions. First, on recording assessments—this might appear to be a minor issue, but it has been raised several times in the debate—will he stand by the commitment he made in Westminster Hall in February that people who want recordings will be able to have them? He seemed to renege on that commitment in the letter to me that was written by officials, but signed by him, about a case that I raised. Secondly, will he get these new descriptors evaluated quickly—he can urge his successor to get a move on—do so transparently, and make the changes quickly after the evaluation is completed?

--- Later in debate ---

[Chris Grayling]

It is a matter of record that since we implemented changes as a result of the Harrington process and the internal review that we inherited from the previous Government, the number of people going into the support group, including the number of people with mental health conditions, has increased. That is a good thing and I am pleased that we made those changes.

The issue of cancer has been raised. It has taken us longer than I expected to address that, because of various issues that arose in our discussions with Macmillan Cancer Support, but I believe that we are now in the right place. We will be making a formal announcement very shortly, but I have said before that I believe that we should extend to those receiving oral chemotherapy the access to the support group that is offered to people receiving intravenous chemotherapy.

[Stephen Timms]

Will the Minister give way?

[Chris Grayling]

I will give way very briefly, but this is the last intervention that I will take.

[Stephen Timms]

The Minister will acknowledge, however, that the new descriptors that have been proposed for mental health conditions and for fluctuating conditions are nowhere near being implemented. When does he expect that they will be implemented?

[Chris Grayling]

I will make just one more point and then I will answer that question.

It is really important to put it on record that Atos does not take decisions. In no circumstance does Atos take a decision about whether somebody receives a benefit or does not. A claimant will be asked to fill in a form that goes to Atos for consideration of whether they should be put to an assessment, or passported straight through to the benefit. Atos carries out the assessment, but the decision about benefits is taken by a Department for Work and Pensions decision maker in Jobcentre Plus. It is really important that people understand that Atos does not take decisions.

When we talk about Atos, we are talking about a team of perhaps 1,500 health care professionals, many of whom have trained in the NHS. Those professionals are carrying out an assessment that was designed by the DWP under the previous Government and that has been continued under the current Government. Atos does not take the decisions itself.

As a result of the Harrington recommendations, we have gone out of our way to address people much more directly. Rather than letters, they now receive phone calls, in which they are asked to bring forward additional evidence. A question was asked about the mandatory reconsideration phase. Effectively, that phase already happens. Every case in which the person says they are not happy will now involve a reconsideration within Jobcentre Plus. I am keen that we have that second opinion, because we will not always get things right and I want to try to see whether we can bring forward further evidence that would enable us to make the right decision before a case ever reached the tribunal service. Effort is being put in to make that happen.

The right hon. Member for East Ham (Stephen Timms) asked about recordings. Let me be clear that Harrington recommended that we carried out a pilot to test recordings. I was keen that we just did it, but Harrington said to me, “Actually, it may not work, so I really think that you should pilot it. It may prove to have a negative effect.” We therefore tested recording and found that there was little enthusiasm among those being assessed to have their assessment recorded. In the end, the conclusion was that we should make recording available on a voluntary basis, but it should not be something that we do across the board.

I do not rule out recording. If there was overwhelming evidence showing that it was necessary, I would make it available, but let me give some statistics. There are 300 claimants waiting for an audio-recorded assessment, while Atos is conducting 8,000 assessments a week. We are ordering additional audio-recording machines so that people can have their assessment recorded, if they want. They are perfectly entitled to bring their own recording equipment to an assessment as long as it can record two copies of an assessment, because they need to be able to take one copy with them and leave the other behind. That is why we have to buy what is fairly expensive equipment, and we have ordered additional equipment because there has been an increase in demand in the last few weeks.

I am perfectly relaxed about recorded assessments and perfectly happy to make recording facilities available. However, the advice that I received from Malcolm Harrington was that we should test recording. The result of the pilot was not only that there was not a need for recording, but that many people felt uncomfortable being assessed with a tape recorder running.

The right hon. Gentleman also asked about the new descriptors that were brought forward by the charities, but he is out of date. The charities have been working with us for the past few weeks on the assessment project of the package that they brought forward. The work was finished last week. The charities wanted more time to work with us because the process is complicated and we are trying to mesh mental health issues and fluctuating conditions. As I said in Westminster Hall about 12 months ago, the problem that I had with the recommendations that the charities made in the first place was that they came forward not simply with adjustments to the existing descriptors, but instead with a comprehensive reorganisation of the assessment, which would also have involved a redesign of the physical descriptors. Given that the right hon. Gentleman has carried out such projects in the DWP, he will know well that that would be a two or three-year project.

We have tried to take forward some of the suggestions that the charities made and embed them into elements such as the ESA50 form, and we are now working with the charities to road test all this work to see whether it really makes a difference. However, I am not going to embark on a major overhaul of the whole exercise based on recommendations that are not backed by evidence without our having tested them in the way in which the previous Government tested recommendations: by putting real cases against proposed descriptors and making a comparison between the outcomes of the theoretical new descriptors and the old descriptors. Such work is on track. We are pushing the charities to make progress, because I want to get the work done, and we are still on track to complete the gold standard review in the spring.

The hon. Member for Rutherglen and Hamilton West (Tom Greatrex) referred to the National Audit Office report. I have had the benefit of having read that report, although I know that he has not. The reality is that the report highlights a number of what I regard as not particularly major areas of improvement. If he reads the report, he will see that it reflects a big and complicated contract. It makes some suggestions for improvement, but it is not as he portrays it.

When the hon. Gentleman talks about the performance of Atos during the last two years, the key point he must remember is that the recommendations that Malcolm Harrington made, combined with some fluctuation in volumes coming through to Atos, which are certainly beyond its control, have caused significant operational difficulties. I can give him my word that I have sat in meetings with representatives of Atos and put them under intense pressure. Atos has brought in extra capacity at cost. We have made sure that we deliver at every stage. However, it is not possible to change the goalposts totally and then expect the subcontractor to take it on the chin with no consequences.

We have seen some consequences of the introduction of the Harrington recommendations, particularly the personalised statement. However, as I stand here today, we are on track to close the backlog time to where it should be later this autumn. The numbers that the hon. Gentleman gave are already well out of date. We have brought down the backlog in the number of appeals that we inherited two years ago, but it is a big task. We are dealing with a large number of people and this is a big challenge.

Let me be clear that we want to get this process right and we want to do the right thing. I want people who need long-term ongoing support to be in the support group. The Government have no interest in doing anything other than looking after those people who need that, but we will also give encouragement and support—and a bit of a push—to those who can get back into work, because I believe that that is the right thing for them.