Benefits (Terminally Ill Patients)

Steve Webb Excerpts

Thursday 9th February 2012 Commons Chamber

[The Minister of State, Department for Work and Pensions (Steve Webb)]

I congratulate the hon. Member for Hackney South and Shoreditch (Meg Hillier) on securing this debate about such an important and sensitive matter. I join her in praising the work of the hospice movement—including St Joseph’s hospice in her constituency—for the care and support it gives terminally ill people and their families, and, as she said, for helping people to access the benefits that, perhaps in many cases, they should have been receiving earlier. I welcome that work, as well as the work of Macmillan Cancer Support, with which the Department works closely on a range of issues.

The hon. Lady has raised some important matters, to which I hope to respond. I can offer her the assurance that the coalition Government seek to put in place structures in the benefits system that treat people with terminal illness with dignity and give them efficient and effective support—as, indeed, did the predecessor Administration. Individual cases have been raised, both by the hon. Lady and by her hon. Friends the Members for Rutherglen and Hamilton West (Tom Greatrex) and for Bishop Auckland (Helen Goodman). I cannot respond to those individual cases immediately, but I can certainly give an undertaking that if any hon. Member here today wants to follow up on those cases with details—national insurance numbers, and so on—we will be keen to do that, because it is by following through what sometimes appears to have gone wrong that we learn lessons that will be of general benefit.

We want to make it clear that if an individual has a terminal illness, they must be entitled to the highest rate of support, and should receive that support quickly and in the most sensitive way possible. As the hon. Member for Hackney South and Shoreditch mentioned, the two key benefits that are relevant to terminally ill people and their families are employment and support allowance, and disability living allowance—or instead, for those of pension age, attendance allowance. In both cases, our aim is to ensure that terminally ill individuals are fast-tracked through the process for DLA and ESA, so that they can receive the highest level of support as quickly as possible, with a minimal burden on them and their family.

Although there are some differences between the two benefits—for reasons that I will explain—there are also common threads, which links in slightly with the hon. Lady’s point about having common treatment for people with terminal illness. One of those threads, quite properly, is that the definition of terminal illness that the Department uses is the same for ESA, DLA and attendance allowance. The definition is, as she said, that an individual is suffering from a progressive disease and that death in consequence of that disease can reasonably be expected within six months. Although that is a standard definition, I stress that there is also a good deal of flexibility built in. Therefore, although the definition is an indicative rule for accessing what are called the special rules, nobody in a jobcentre or a benefits processing centre will say, “Well, if it’s six months and a day, forget about it.” The definition is intended to be applied as flexibly and sensitively as possible.

Let me give an indication of the extent to which people qualify under the special rules scheme—that is, let me place before the House some indications, as it were, of where the system is delivering as it should. As the hon. Lady said, 4,200 people are placed directly in the support group—which is for non-time-limited support—for employment and support allowance owing to terminal illness each year. Around 22,000 people are awarded DLA owing to a terminal illness, while 38,000 people are awarded AA, which is obviously for older claimants, owing to a terminal illness each year. Therefore, although there will be some overlap between the two groups, roughly 65,000 people are, quite properly, accessing the special rules, which get their claims fast-tracked, so that they can be put straight on to the highest rates.

I want to say a bit more about the process that should be followed. The hon. Lady asked why there was no fast-tracking for employment and support allowance. I can assure her that there is. Individuals are fast-tracked into the support group, and they receive financial support, which is currently £113.90 for a single adult over 25. No obligations are placed on them to look for work or to undertake work-related activity.

[Tom Greatrex]

Will the Minister give way?

[Steve Webb]

I will not, if the hon. Gentleman does not mind. This is the hon. Lady’s debate, and I have only a few minutes in which to respond.

Unlike other claimants to employment and support allowance, individuals who are terminally ill are paid the support group component backdated to the date of claim. So, the assessment period, during which those making a standard claim would be paid at a lower rate, does not apply. Once we have identified that someone is terminally ill and put them in the support group, their payment at the higher rate is backdated to week one; they are not paid the lower 13-week assessment rate. That is quite properly an additional source of support. Similarly for disability living allowance, individuals are fast-tracked to the highest rate of the care component, which is currently worth £73.60. They do not have to satisfy the normal entitlement conditions for the care component, or meet the usual qualifying period of three months. These have all been features of the system for some time, and they are designed specifically to assist terminally ill people.

The hon. Lady also, quite properly, raised the issue of people finding out in an inappropriate manner that they are terminally ill. It is totally unacceptable for someone to find that out from a jobcentre or over the phone: that simply should not happen.

[Meg Hillier]

I thank the Minister for that categorical statement. Would it not be easier for DWP assessors simply to check the disability living allowance database? They would not then have to ask for a form, which would make life a lot easier for the patient.

[Steve Webb]

Absolutely. Atos was awarded the contract to do the face-to-face assessments some years ago. In regard to data sharing, it would be aware that a DS1500 form had been completed for a claimant, so it should not need to ask for another form to be completed. I would be keen to hear about any individual cases in which that has none the less happened, when it should not have done, and we will follow them up. The intention is that, whenever possible, these matters should be dealt with on the basis of paperwork and forms that have already been submitted, rather than calling people in for a face-to-face assessment. As the hon. Lady says, calling them in is inappropriate and unnecessary, and it also costs money. There is no reason why anyone would want it to happen, and we are keen to ensure that it does not.

We also recognise that some people do not know, or do not wish to know, that they are terminally ill. The provisions for DLA allow a claim to be made for such people under the special rules by a third party, and such a claim will be handled sensitively to ensure that the prognosis is not revealed to the terminally ill person. For both benefits—DLA and ESA—processes are in place to ensure speedy access to benefits and minimal form filling. I shall talk the House briefly through the process involved. The claim is sent for urgent medical advice from medical services, which have 48 hours to provide advice on whether the individual meets the terminal illness criteria. Performance data over the last year on the typical turnaround time for these applications show that medical services are providing advice in an average of 1.2 days for ESA claims, and an average of 1.5 days for DLA claims. In general, therefore, these claims are being turned round very quickly, and rightly so.

To provide this advice, medical services can contact the claimant’s GP, or the treating health care professional, to check whether they are already receiving DLA due to terminal illness. Advice is then provided to a decision maker, who makes a judgment on the balance of probabilities and has some discretion. The whole process should take no longer than a week from start to finish. Claims for employment and support allowance are currently taking just over seven working days, and claims for disability living allowance are taking just under six working days.

Appeals have been mentioned, and I would be the first to accept that it is taking too long to deal with them. These matters are handled by the tribunals service, under the Ministry of Justice, and we are working closely with the service to try to reduce the backlog. Some progress has been made. For most of this year, the number of new cases coming in has been lower than the number of appeals cleared, but I freely accept that it is still taking too long.

There are a lot of reassessments taking place at the moment, involving people who have been on incapacity benefit for a long time, and the volume of appeals is inevitably rising as a result. When someone appeals, they stay on benefit in the meantime. I am talking now about general decisions on IB, rather than those for terminally ill people. Appealing enables the benefit to continue, so there is quite a strong incentive to do so, and the volume of appeals has greatly increased.

We are taking steps to address that. First, we are dealing with appeals more quickly. The volume of appeals processed by the tribunals service has been 66% higher in the first seven months of 2011-12 compared with 2009-10. There is much greater throughput, therefore. Secondly, we must try to get the decisions right in the first place. That is in everybody’s interests. I am proud of the Harrington review process, which analysed the very flawed work capability assessment. Professor Harrington produced his first report, and the Department accepted all his recommendations and has been implementing them. Professor Harrington has reported back, saying the Department is doing a pretty good job in taking on his recommendations. He has now produced a second round of recommendations. As I have said, the key is to get these decisions right in the first place, and we are finding that the rate of successful appeals against WCA decisions is significantly lower than under the old personal capability assessment.

[Meg Hillier]

That is all very well for the bulk of cases, but the key point in today’s debate is that those who are terminally ill should not have to go through an appeal in the first place. Speed of delivery is also important. We are hearing of serious delays for people with a terminal illness. Will the Minister move on to the element of his remarks that deal with that?

--- Later in debate ---

[Steve Webb]

One problem is that defining someone as terminally ill for the purposes of the special rules involves the notion of a six-month prognosis. The hon. Lady will appreciate that this is not a science, and that it is hard to predict with any degree of certainty. Somebody might be identified, perhaps even by their clinicians, as having a longer prognosis, and the appeals service will in such cases look again at the initial decision. We are trying to make those decisions as swiftly as possible. If a decision is made to take somebody off benefit, their benefit continues while they await the appeal, and it is important that it should.

The hon. Lady mentioned fast-tracking of ESA applications, and that is in place. If someone is identified as having a terminal illness, when they have their WCA a flag should be set because those deemed to be terminally ill should not be contacted for three years. That is the norm; that should be what happens. However, some conditions—HIV, for example—used to be regarded as terminal, but now they are not. There is therefore a sort of backstop that, in effect, says that after three years the person in question may be contacted. In general, however, people will not be contacted again. We are continually looking to ensure that robust processes are in place for the sorts of cases the hon. Lady mentions, and I will raise this important issue with operational colleagues on the front line.

The hon. Lady asked why we do not have a single central service. One of the dilemmas we face is that people always tell us they want DLA and ESA to be seen separately. DLA is about the costs of disability and has nothing to do with work. Some people ask why we do not have a single form or system, but there is a danger of muddying the waters. Claimants’ organisations tend to ask us to keep them separate, and say that DLA should not be about pressurising people to work, and that instead it should be about meeting the costs of care.

I thank the hon. Lady for raising these issues. I have set out what the Department is seeking to do to help terminally ill people with their benefit claims, but I would be very happy to follow up any individual cases Members want to bring to our attention.

Question put and agreed to.