Long Covid

Steve Baker Excerpts

Thursday 24th February 2022 Commons Chamber

[Mr Steve Baker (Wycombe) (Con)]

Would antibody testing achieve the aim the hon. Member intends, rather than antigen testing, which is what we are currently doing?

[Wendy Chamberlain]

I thank the hon. Member for his intervention. I would accept either testing, but I am asking that proof of a positive test does not need to be a requirement for a diagnosis of long covid. Of course, it would be better for many reasons to just keep testing everyone, but failing this, I ask the Minister to speak to his colleagues in the Department of Health about how long covid can be diagnosed without a test result, and to commit to making sure it is not required for recognition of the disease by his own Department.

I am sure that, in his remarks, the Minister will tell me that there is no evidence of a problem of long covid and keeping people in work, but that is because the information is not being collected. As I have said, 1.3 million people have long covid, and of those almost two thirds report an impact on their ability to carry out their daily lives. It is logical to assume that this includes employment—getting up, commuting, concentrating and completing a full day of work—and I would urge the Minister urgently to collect the data needed to find out the extent to which people with long covid are struggling at work.

I also urge the Minister urgently to provide guidance to employers as to how they can support employees with long covid. At the very least, affected staff need understanding, but beyond this, employers need to know what reasonable adjustments are appropriate, how to support staff who are on long-term sick leave and how to adjust their business practices to function in the face of increased absences. I have some experience in that I worked for a time in human resources—I have some experience with dealing with issues that arise as a result of long-term health conditions—and I have great sympathy for those in human resources who are tackling this problem now on behalf of their employers.

This problem may be larger for some employers than others, particularly given the number of key workers who caught covid by working on the frontline during the first waves of the pandemic, and I have been written to by many constituents in this position. To mention just one, a constituent of mine was working as a healthcare support worker in the first wave of the pandemic when she caught covid from a patient and, as a result of long covid, she has been unable to return to work. Her employer, the local council, wants to help, but it does not know what is best to do. There will be thousands of employees in the same position all around the country, and employers need guidance from the DWP about the condition, and what support they can and should be expected to give. In this regard, I am told that it would be helpful if long covid was classified as an occupational disease. I therefore ask the Minister to use his time today to advise whether that is under consideration, and then to bring forward such guidance as a matter of urgency.

I am sure the Minister will agree with me in hoping that, with the right support and guidance, most people experiencing long covid will be able to stay in their jobs—to keep working, to keep earning, to continue in their careers—but, sadly, that will not be the case for everybody. There will be those who cannot work as much as they used to or who cannot work at all, and that is where our social security system steps up. As the Minister knows, it is already official Government guidance that for

“anyone with a disability or long-term health condition, including long Covid, there is a strong financial safety net”,

and it goes on to list available support as statutory sick pay, universal credit and personal independence payments.

However, as is so often the case with benefits, it is not that easy. Applying for benefits is complicated, as there are a lot of forms, a lot of boxes to tick and a lot of assessments. When someone has a debilitating condition such as long covid or one of the other relapsing-remitting diseases I have already mentioned, they may not be able to sit and complete a 30-page form in one go, or even in the course of a week or two. Research by the MS Society has shown that a third of people with MS thought four weeks was not enough time to complete the forms, but the majority of applicants did not know that they could request a two-week extension.

One solution is simply to extend the time allowed to complete the forms. There is no incentive for claimants to take excessive time because they want to get the support that they need. Meanwhile, DWP resources are used up requiring people to request extensions. Setting the time to return the forms at eight weeks would be a simple and cheap solution. If the Minister disagrees and prefers a system that does not work for disabled people and also costs his Department money, will he at least commit to including clear information on the PIP application form on how people go about applying for an extension?

While we are thinking about the forms, does the Minister agree with me that the forms ought to be designed to be usable by the people completing them? People with relapsing-remitting conditions, of which long covid is just one, do not find those forms usable. There is no space on the forms properly to explain the impact of having fluctuating symptoms. They do not work for people with long covid, and these forms must be fit for purpose. I strongly encourage the Minister to consult with disabled people on this.

Long covid is a novel condition, and the DWP, like all of us, is having to learn and adapt, but as DWP staff see more and more individuals with long covid, it is vital that they receive the appropriate guidance and training. Universal credit requires claimants who can do so to look for work. In fact, more recently it required claimants quite quickly to look for just any work at all. Are work coaches trained in what sort of requirements are appropriate for someone with a relapsing remitting disease, where they fatigue quickly or have brain fog or any of the other hundred-odd symptoms of long covid? I look forward to hearing from the Minister about what guidance is in place and what support is offered, but I fear there is little.

The same is true for personal independence assessments. A PIP assessment is supposed to determine what additional support someone needs as a result of their disability or illness, but again that is an impossible test for anybody with a fluctuating condition. They could be functioning one day, or even ok, but the next day they are unable to get out of bed. One assessment—just one assessment on one day—determines whether they get support or not, and that system does not work. Of course, the system is failing not only long covid sufferers, but those with ME, multiple sclerosis and chronic pain, to name a few. There is a simple solution that I ask the Minister to adopt, which is to allow more weight to be given to medical evidence and the information provided by doctors and experts on someone’s condition, or by those people who see claimants on their good days and on their bad days. It is an obvious solution.

There are other ways that the assessment process could be reformed better to support all disabled people, including those with long covid: using specialist assessors, ending the five-week waiting period and increasing payments in line with inflation are vital for the health and wellbeing of all disabled people. I await the publication of the Government’s White Paper this spring, and wonder whether the Minister is able to provide an update on that this evening.

However, those with long covid cannot wait until then for their condition to be properly recognised by the DWP and their employers. The pandemic has been the biggest mass-disabling event since the first world war, and long covid is not going away. We have seen covid rip through classrooms over the past few months. Long covid does not just affect people of working age, and children who suffer from it are going to miss education and training. It does not matter if, like me, someone views social security as a public service and a safety net, or if they see the DWP as a means to get people into work. From either perspective, the Government must do more to support those with long covid to stay in work, get into work, and get the support they need if they cannot work.

We need information about the impact of long covid on employment, and a formal recognition of long covid as a debilitating condition, or an occupational health disease that affects someone’s ability to work. We need proper guidance and training for employers and DWP staff, and an assessment process that works for people with fluctuating symptoms. The Prime Minister told us on Monday that it was time to get our confidence back, but those words are cold comfort to those suffering from the debilitating impacts of long covid. They need practical support and they need it now, and I urge the Minister to heed them.

[The Parliamentary Under-Secretary of State for Work and Pensions (Guy Opperman)]

The Russian invasion of Ukraine colours everything we talk about today, and I wish to put on record my support for what has been said by all political parties. I am sure I speak for all colleagues on both Front and Back Benches when I say that we stand with the people of a sovereign and independent Ukraine. We are a legitimate democracy, which means that we can debate things. We can have a discussion in a way that other countries, such as Russia, cannot do. I congratulate the hon. Member for North East Fife (Wendy Chamberlain) on securing this important debate on an important issue. As she knows, the Minister for Disabled People, Work and Health, who would normally respond to this debate, cannot be with us tonight because of personal reasons. She apologises for that, and I am here to respond to the best of my ability on all matters on behalf of the Government.

The Government recognise the impact of long covid on individuals and their families. We are committed to working across the Government to ensure that appropriate provision and support is available to those suffering from the condition of covid. The hon. Lady is right to say that we have been through the worst pandemic since the Spanish flu of 1919, and all Governments around the world are playing catch-up in an attempt to understand, appreciate and deal with the consequences of this terrible disease. It is also a chance for us in this House to put on record our thanks to the pharmaceutical companies, everyone behind the vaccine taskforce, the NHS, the public and private sectors, and the volunteers behind the vaccine roll-out.

We cannot discuss covid without raising the specific issue that it is in everybody’s interests to get the jab. I have done everything possible, including videos with my dog, Zola, to encourage vaccine take-up, and it is very much in our interests to have a continuation of that take-up. Sadly, however, a significant proportion of the population have still not had the jab, and we urge them to go forward and do that.

[Mr Steve Baker]

One thing I notice when I look at the vaccination map brilliantly provided by the Government is that the areas of Wycombe with the highest ethnic minority populations are the least vaccinated. Will the Minister take this opportunity, if he can, to tell us a bit more about what the Government are doing to help those people?

[Guy Opperman]

A great deal is being done; I will write to my hon. Friend and set it out in copious detail. The most important thing is that thought leaders, whether voted for or not—they range from Members of Parliament to religious leaders and community leaders—make the case in their communities that people need to get the jab, because the way out of this and back to normal life and living with covid is clearly to embrace the vaccine. There is much more that I could touch on, but that is the main point.

Specific guidance was set out in the detailed “COVID-19 Response: Living with COVID-19” document put forward by the Prime Minister. The hon. Lady said that there was no reference in the Prime Minister’s statement to long covid. That is not the case for the document—I refer her in particular to paragraphs 87 and 118—but this is clearly a work in progress. I will come to the specifics in a bit more detail. We remain committed to ensuring that everybody can access the health and support that they need. We are doing what we can to ensure that care pathways are available and clearly signposted so that people who need extra help receive it.

The hon. Lady rightly mentioned that she is a Scottish MP and that this is a devolved system. I will therefore briefly touch on the health approach before turning to benefits. The Department of Health and Social Care has invested over £50 million in dedicated research to improve the diagnosis and treatment of long covid. In addition, NHS England and NHS Improvement have invested £224 million to provide care for people with long covid, including £90 million in 2022-23. There are 90 long covid assessment services across England, including 14 specialist paediatric hubs that have been established to support adults, children and young people with long covid and to direct them into appropriate care pathways.

The Government recognise that while England has adopted a clinic-based service model, no one single approach is likely to fit all areas and circumstances, and it is right and proper that each part of the UK can adopt a service model for long covid that most effectively responds to its patients’ needs. That recognises that—this goes to the hon. Lady’s point—everyone experiences long covid differently and that health services are organised differently depending on where they are located.

In Scotland, I understand, NHS boards are developing pathways between primary and secondary care according to local services and the needs of their respective populations, with a focus on providing care and support that is as close to home as possible. In Northern Ireland, assessment services have been established featuring multidisciplinary assessment and support in primary and secondary care settings. Similarly, in Wales, a recovery programme has been established whereby the majority of people accessing services will do so directly via their GP practice and, following assessment, people may be supported by a range of healthcare professionals depending on their individual needs.

I turn to benefit entitlement. It is vital that the existing benefit system provides inclusive, accessible and sustainable support to all people with health conditions that impact on their ability to work and participate fully in society. That includes, obviously, people with long covid. However, the benefit system is set up to consider the impact that a health condition has on an individual’s ability to work and carry out day-to-day activities. In the case of long covid, there would be an assessment of a person’s needs in the same way as for other conditions, by understanding its impact on their day-to-day activities.

Claimants can apply for benefits on the basis of their symptoms and the impact that those symptoms are having on them. The hon. Lady rightly outlined that there are a multitude of different symptoms, which goes to my point that the NHS in the UK and particularly in England—I cannot speak in detail for the Scottish NHS—is making great efforts to better understand diagnosis and treatment. Clearly, however, the main symptoms would be pain, fatigue, breathlessness and some things that are akin in many ways to ME and other illnesses. Clearly, how those symptoms fluctuate is particularly relevant to long covid and the ability to function on an ongoing basis.

Assessments for health and disability benefits take those matters into consideration. Our healthcare professionals are trained to explore and evaluate those factors. Overall, there are three ways in which we assess a claimant’s needs. First, irrespective of a person’s income or whether they are in or out of work, we can assess mobility or care needs through the disability living allowance, the personal independence payment and the attendance allowance. For the current financial year 2021-22, PIP alone will provide around 2 million people of working age with £12.2 billion of support.

Secondly, we can also look at a person’s capability for work to understand if, owing to the impacts of a health condition, they might have difficulty finding and keeping a job. We assess that through the work capability assessment, which provides access to the employment and support allowance and the additional health-related element of universal credit. Anybody who is unable to work can claim those benefits. New-style ESA provides support to those with sufficient national insurance contributions, and universal credit provides support for those without contributions. Overall, in 2021—I accept that it is an ongoing process—we are supporting over three-quarters of a million people on the universal credit health journey and spend over £17 billion a year on working-age benefits or incapacity.

That brings me to the third type of need that we must address, which is financial need, whereby the system of universal credit looks at a household’s situation in and out of work, and provides support according to that household’s financial needs. For those out of work, it is also the main gateway to access Jobcentre Plus support to help them get back into work.

The hon. Lady referred to industrial injuries. I cannot speak to the specifics for Scotland, but the Department for Work and Pensions is responsible for the industrial injuries scheme, which compensates for injuries arising from an industrial accident or a disease contracted as a result of a person’s occupation. The Industrial Injuries Advisory Council advises the Secretary of State for Work and Pensions regarding industrial injuries disablement benefit, and is considering available scientific and epidemiological evidence on long covid. IIAC does not specifically apply in Scotland. It is important to add that any changes to the scheme can be recommended only where there is sufficiently robust evidence. However, it is reviewing the available evidence on an ongoing basis to inform on whether long covid can and should be prescribed as an occupational disease for the purposes of industrial injuries disablement benefit. The House will be updated as that work progresses.

In addition, work is being done on occupational health support. The hon. Lady will be aware that in July 2021 we published the response to the “Health is Everyone’s Business” consultation—if she is not, she should look at it—which specifically sets out the measures the Government are taking to help employers better navigate the work and health system. They include improved access to occupational health, particularly for employees of smaller employers and self-employed people who are least likely to have access; testing a new occupational health financial incentive; and stimulating the development of innovative quality services while addressing workforce capacity constraints.

In addition, there is clearly a situation in respect of data on long covid. I am aware of the figures from the Office for National Statistics which the hon. Lady cites, but they are not necessarily a reflection of what the NHS is seeing. The nature of that particular report would disagree with, for example, the NHS England activity data. I will read out some of the figures, as they are published. Information is published on activity and demographic characteristics of patients referred to a post-covid assessment clinic in England. For the period 22 November 2021 to 19 December 2021, there were 5,539 referrals to NHS post-covid assessment services, 458 fewer than in previous weeks. Of those, 4,946 were accepted as clinically appropriate for assessment. There were 4,750 initial specialist appointments assessments, which were completed together with 8,695 follow-up appointments. Those figures are the highest reported since publication of that data commenced.

A whole host of further long covid research is being done through the National Institute for Health Research and UK Research and Innovation, which invested some £50 million in research to better understand long covid and to treat it. My strong advice to the hon. Lady is that she sits down with Health Department colleagues from Scotland and this country with a view to getting the details on that. I cannot give more information about that tonight given the limited time that I have.

Clearly, however, a lot of work is being done. There is £8.4 million being spent on the post-hospitalisation covid-19 study at the University of Leicester, and £18 million of funding has been given to four research studies to better understand and address the long-term effects of covid-19 on physical and mental health. The studies will examine the causes, consequences and treatment of what is known as long covid. Similarly, a further £19 million has been given to 15 research studies to accelerate the development of new ways to diagnose and treat long covid as well as to consider how to configure services to provide the absolute best healthcare. It is clear that this is a work in progress. This is a journey. It is important that the hon. Lady raises these points and we debate them, and that we all understand that the journey is not complete.

In conclusion, the Government recognise that long covid can have a significant impact on individuals and their families. We are committed to working across Government to ensure that people suffering from this terrible condition can access the appropriate provision and support. The initial £50 million investment in research to improve the diagnosis and treatment will help us to understand the condition and its impact more fully. That, alongside investment in expanding care and assessment facilities for patients, shows that the Government recognise the condition and are acting.

In addition, the Department for Work and Pensions provides a great deal of financial support in the ways that I have outlined, which enables those affected by the pandemic to access the help that they need. We will carefully monitor and consider the advice of the Industrial Injuries Advisory Council regarding long covid. We remain committed to this support. We continue to review our approach and to ensure that there is ongoing support, and I thank the hon. Lady for the points that she has raised tonight.

Question put and agreed to.