Work Capability Assessments

Tom Greatrex Excerpts

Wednesday 1st February 2012 Westminster Hall

[Tom Greatrex (Rutherglen and Hamilton West) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship for the first time, Mr Williams.

I am grateful to have the opportunity to raise the issue of work capability assessments, and I note that the number of right hon. and hon. Members present indicates a degree of interest that merits us having a debate that is often misrepresented. From the outset, I must make two important points. First, I support the principle behind work capability assessments; some Members are against them in principle, but I am not. I agree that those who seek sickness benefit should be assessed to determine their fitness for work. Of all the many constituents who have contacted me on the matter over almost two years, none has disagreed with the principle behind an assessment—that people who can work ought to be helped into work where jobs are available. There are many benefits, which I have seen for myself with constituents who have been able to find work, although they previously thought that they might not work again. Those benefits are not merely economic but relate to health and well-being, and we should not confuse the debate by suggesting otherwise.

To support the principle, however, does not mean ignoring the current chaos of the work capability assessment in practice. Increasingly, over the past 12 months in particular, we have seen a chaotic process, which takes an inordinate amount of time, causes great anxiety for many, takes up huge amounts of public money, especially in the appeals process, and is doing a disservice both to those who want to get back to work and to those who will not be able to work.

The Government, in particular the Minister of State, Department for Work and Pensions, the right hon. Member for Epsom and Ewell (Chris Grayling), with whom I have discussed the situation in the Chamber and in meetings a number of times, have a habit of deflecting responsibility for how the system operates. Too often, the Minister has a ready excuse for the failings of the work capability assessment. Sometimes, he blames the previous Government, and sometimes he claims that people need to have patience to allow reforms to bed in, but I am not sure that I have ever heard him accept responsibility for the mess that the system is currently in. Part of the reason for that mess is the speed of the roll-out, despite the warnings of the pilot process and the report of the Select Committee on Work and Pensions.

About 11,000 people a week currently undergo the work capability assessment. Between 40% and 70% of those who appeal their assessment win their appeals, depending on whether they are represented. Is it any wonder that the cost of appeals is on track to reach £60 million for 2011-12, up by £20 million on the previous year? Is it any wonder that the number of tribunal service staff has increased by 30% since January 2010? Is it any wonder that tribunal centres, including the one in my area, in Hamilton, now operate on Saturdays to cope with the huge backlog of appeals? The system may have been put in place before the Minister took office, but by signing off on the nationwide roll-out, which has clogged the system, and by not dealing with the defects, the Government now have ownership of the problems and should be dealing with them.

Professor Malcolm Harrington, in his first review of the work capability assessment, made a number of important recommendations to improve the system. The Secretary of State for Work and Pensions welcomed the report and said that he fully endorsed the recommendations. The Minister said:

“We fully endorse Professor Harrington’s recommendations... We believe that the principles of the assessment are right, but that the system which we inherited contained some flaws that risked undermining its effectiveness. We have moved swiftly to put those right.”

Yet in Harrington’s review of the second year, published in November last year, he made it clear that the users of the system, including benefit claimants and the organisations working with them, have seen no difference. The review cited one survey by the Disability Benefits Consortium, which asked 439 welfare rights advisers during the summer of last year whether they had noticed any improvement since the first Harrington review: an incredible 75% reported no change and fewer than 4% saw improvements. That is a damning indictment of the Government’s failure to implement proper change to make the system fairer, not only for those who use it but for the taxpayers who fund it.

One example of the Government’s failure to follow through on its welcome of Harrington’s recommendations relates to the performance of Atos Healthcare. Atos is the multi-billion-pound French IT firm that receives £100 million a year from the Department for Work and Pensions to carry out the work capability assessment. The Atos website, which I am sure the Minister is as familiar with as I am, boasts of global turnover of €8.7 million; Atos employs 78,500 people around the world.

[Mr Wayne David (Caerphilly) (Lab)]

Before my hon. Friend goes into details about why Atos is probably failing as a medical assessment organisation, does he agree that part of the problem begins with the attitude of many of the staff engaged by Atos and their total unprofessionalism?

[Tom Greatrex]

My hon. Friend is entirely right. I have been contacted in the run-up to the debate by a variety of organisations giving me examples, and I have others from my own constituents, of how the process has failed and how it works and does not work. The process does not properly take account of a whole range of issues, from people with fluctuating or mental health conditions down to how people feel and how they are treated when they go into the assessment—for example, the people doing the assessments not making eye contact or asking leading questions to get an answer that is nothing to do with the health conditions.

[Richard Fuller (Bedford) (Con)]

I became a Member of Parliament in 2010 and, right from the start, people expressed concerns to me about the work capability assessment, which was introduced by the previous Government. Can the hon. Gentleman confirm that Atos was hired by that previous Labour Government? Were some of the concerns that he was beginning to talk about exhibited at that stage, or are they only coming to light now?

[Tom Greatrex]

The hon. Gentleman must know the answer to his question, but I have not suggested that the contract was agreed under the current Government.

[Esther McVey (Wirral West) (Con)]

Ah!

[Tom Greatrex]

I do not know why the hon. Lady says “Ah!” from a sedentary position as though that was some great revelation, because no one has suggested anything else. After the pilots, the Select Committee report highlighted issues that should then have been dealt with, but rather than dealing with them, the Minister decided to roll out the process. That is the root of the problems, such as the huge backlog of appeals, the huge cost to the public purse of dealing with those appeals and the huge anxiety and concern of many people. Many people have worked for a number of years and now find themselves, through no fault of their own, unable to continue in their previous line of work, and they would appreciate help to get into work; many others, frankly, are no longer able to work. The process was rolled out without its problems being addressed first, and given how the system is operating, those concerns are now coming home to roost.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

Some of us who were Members before 2010 expressed concern to the previous Government. A serious issue in my constituency is the higher incidence than the national average of mental health problems, and some of those people affected have come to see me. One brave gentleman explained exactly how he had gone through the process, which involved a half-hour interview and a tick-box approach that did not take into account the challenges of mental health. As with many of my constituents with mental health problems, he would really like to work, but that short, sharp, tick-box system is not how to help people. I am sure my hon. Friend agrees.

[Tom Greatrex]

I entirely agree with my hon. Friend. Such issues were among those identified. My contention is that those problems should have been dealt with before the system was rolled out further, and we are now dealing with the consequences of those decisions.

The Atos half-yearly report for 2011 was very upbeat. It noted that operating margins had increased year on year to €166 million—an 11% increase from the first half of 2010. Its operating margin in the UK in 2011 was a healthy €34 million. The outlook for the second half of 2011 was similarly rosy: Atos expected profits to increase by 6.2%. I say all that not to congratulate Atos and marvel at how successful it has been, but to preface my next remarks.

Recommendation 13 of Professor Harrington’s first review was

“better communication between Decision Makers and Atos healthcare professionals to deal with borderline cases”.

In their initial official response to Harrington’s 2010 review, the Government accepted that recommendation, noting:

“Decision Makers already contact Atos healthcare professionals to discuss individual case issues in some instances… we will ensure this happens more often… Agreed measures will be adopted nationally during 2011.”

In a letter that I received from the DWP dated 1 November 2011, I was advised that good progress had been made on that key Harrington recommendation. The DWP letter claimed that

“Atos Healthcare Professional deployment in Benefit Centres has been trialled and has proven to be an effective way of improving communications to discuss borderline cases.”

However, on 20 December 2011, just over six weeks later, in answer to a written question that I had tabled, the Minister advised that

“at the end of the trial, Atos health care professional capacity pressures meant that the initiative could not be continued. From the start of December, DWP and Atos have agreed the implementation of a telephone helpline so that Decision Makers can speak directly to health care professionals to obtain medical advice in specific cases. This is an interim arrangement until Atos are in a position to reintroduce the deployment of health care professionals in benefit centres.”—[Official Report, 20 December 2011; Vol. 537, c. 1082W.]

That is a hugely significant development. This may have been due to when I tabled the question or when the Minister chose to answer it, but he slipped that answer out just before the Christmas holidays. The fact that Government policy is not being followed by a company in receipt of £100 million of taxpayer funding a year will startle many of my constituents and, I am sure, the constituents of many other right hon. and hon. Members.

I should be grateful to the Minister if he gave me answers to a number of questions. What exactly does the phrase “capacity pressures” mean? Does it mean that Atos cannot recruit the right number of health care professionals to undertake its work? Is it unable to fulfil its contractual obligations because of the amount of work that it has to get through? What discussions has he had with Atos about those capacity pressures? Does he believe that they undermine the ability of Atos to fulfil its responsibilities under the contract? What other services have been withdrawn as a result of capacity pressures in Atos? I am sure that if he is not able to answer, I will find a way of crafting written questions to get the answers from him.

To me, the phrase “capacity pressures” implies an undermining of the way in which the Government sought to deal with these issues, which was by saying that Harrington’s recommendations would be implemented in full. If that is not happening in the instance to which I have referred and perhaps in other instances because of capacity pressures in Atos, is that not a damning indictment of the failure of the system as it is currently set up?

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this matter to the House. No one decries the need for profit, but is it not time that we got away from profit and on to service delivery? Does the hon. Gentleman share my concerns about many patients who go through the process of a work capability assessment and particularly those with cancer, whose health deteriorates when they experience more stress? There should be an emphasis on people’s health, rather than on the profit at the end of the year.

[Tom Greatrex]

I thank the hon. Gentleman for his intervention. He puts his finger on a very important point. I am referring to the anxiety and concern that the process causes people, particularly if they are waiting for an assessment. If they enter the appeal process when they have had an assessment, they could wait up to eight months for an appeal. There is an issue about the whole of that process. Long time scales are involved because of the sheer number of people who are being dealt with—or not being dealt with. At the same time, we should never forget that those individuals are trying to deal with the process, and they are feeling huge anxiety. Particularly if they are already unwell, that could well affect their health. That is an important point.

[Jessica Morden (Newport East) (Lab)]

I congratulate my hon. Friend on securing the debate. Does he, like me, see constituents who are caught in a cycle, in that they get zero points when they go for the work capability assessment, they wait seven months for an appeal, the decision is overturned and they immediately receive another letter asking them to take part in another round of assessments? Does he agree that the stress and anxiety being placed on people with very serious conditions is unacceptable?

[Tom Greatrex]

My hon. Friend is absolutely right. I will go on to highlight the case of one of my constituents that I do not believe is atypical of the experience of many right hon. and hon. Members’ constituents. They get caught up in a process that seems never to end, and as my hon. Friend says, that does their health no good at all.

Last December, Citizens Advice published a damning report on the work capability assessment. One of its recommendations was that financial sanctions should be imposed on Atos for the number of incorrect assessments that it makes. As we all know, the taxpayer forks out millions of pounds on the appeals process, to clear up the incorrect decisions initially made by Atos. The Minister takes a strong interest in Scottish affairs. He may well have seen Scotland Office questions a couple of weeks ago. His colleague, the Under-Secretary of State for Scotland, advised me that he and the Secretary of State for Scotland had discussed the issue with Professor Harrington and that they believed it would be addressed. Can the Minister confirm that that is the case? What time scale has he in mind for financial penalties? Does he believe that Atos should compensate the taxpayer for its performance—its failure in many cases? I should be grateful to the Minister if he clarified the Government’s position on that issue.

Ninety minutes is not sufficient time to debate fully the myriad issues that surround the work capability assessment. I could easily fill the time myself by highlighting its flaws and asking the Minister questions. I am sure that he will be relieved to hear that I do not intend to do that. I intend to make just a couple more remarks and then to allow other hon. Members to speak.

[Mr Russell Brown (Dumfries and Galloway) (Lab)]

I thank my hon. Friend for securing the debate. I am intervening in case he is not about to move on to the issue that I want to raise. There are real problems for people with sensory impairment—a number of charities have come together on this issue—because the whole concept of being in the workplace is to be able to perform any task accurately and swiftly. That is key in the workplace. Does he recognise the pressure that those charities are bringing to bear, in that more emphasis should be placed on the guidance that any activity should be able to be undertaken “safely, reliably and repeatedly”?

[Tom Greatrex]

My hon. Friend makes a very important point. It is no good having someone go to an assessment if the fact that they can sit in a chair or pick up a box and move it once from one part of a room to another means that they are considered able to carry out a task that they may be asked to do repeatedly or continuously in a potential job. That point has been made by a number of organisations that have contacted me about the work capability assessment in the past few days.

I will put to the Minister a few more questions, to which I hope he will respond. They arise from concerns that have been raised by individuals who have contacted me to pass on their experiences of the work capability assessment. Can the Minister confirm whether Atos approved health care professionals are bound by the Official Secrets Act? If they are not, can he confirm whether there are any legally binding conditions, aside from the normal patient confidentiality rules, that prevent Atos approved health care professionals from discussing their experience of the work capability assessment?

As the first Harrington review pointed out, audio recording of the work capability assessment could drive up the quality of assessments by improving assessor and claimant behaviour. Late last year, the Minister advised that he was considering the outcome of the trial in Newcastle of the audio recording of assessments. Will he update the House on when he expects to reach a conclusion on that and whether he will publish the outcome of the trial to ensure full transparency on the issue? He will be aware of the freedom of information request submitted to his Department. Given that many other organisations routinely record their conversations with members of the public to ensure that they are meeting the necessary standards—those organisations range from banks to train companies; I think that even the Independent Parliamentary Standards Authority does it—it should be considered. We need to move on from the trial as quickly as possible. Will the Minister update us on the outcome of the trial?

Individuals who undergo the work capability assessment complete a quality survey to rate the performance of Atos. The survey takes place after the assessment has been completed, but before the claimant is made aware of its findings, which is rather like asking someone for a product evaluation as they leave the shop, before they have had a chance to use the product.

[Nia Griffith (Llanelli) (Lab)]

Does my hon. Friend agree that it is unacceptable that people have to travel 20 miles from the sizeable town of Llanelli to Carmarthen, a local town, where they then find themselves in a lift that does not reach the correct floor, and has a step that leads to a floor without adequate fire escape facilities? Will he ask the Minister what inspections are made of the premises used by Atos with regard to their accessibility for the vulnerable people who have to use them?

[Tom Greatrex]

My hon. Friend makes an important and pertinent point that I hope the Minister will address. It is a real concern if some of the facilities used by people undertaking a work capability assessment are in such a state.

[Pamela Nash (Airdrie and Shotts) (Lab)]

I congratulate my hon. Friend on securing this crucial debate. My constituents share the same assessment centre that my hon. Friend’s constituents use in Hamilton, and their experiences suggest that the building is not suitable for carrying out a work capability assessment. It has no disabled access and the car park is 80 yards from the front door. People are only supposed to walk 40 yards, and they feel as if they are being tricked before the assessment takes place.

Another problem is that information is unofficially gathered during the assessments. One of my constituents is deaf, but he was told that he could not possibly be deaf because he heard his name being called in the waiting room. Clearly, while he was waiting he was looking at the door in order to lip-read. Have my hon. Friend’s constituents shared experiences such as those at the Atos centre in Hamilton?

[Tom Greatrex]

My hon. Friend makes a couple of important points. In some ways, a deaf constituent being told that he is not deaf because he heard his name being called is symptomatic of the attitude held by some of the people who carry out the assessments. I am sure that all hon. Members have heard about such experiences from a number of constituents, and it does the principle of helping people into work a gross disservice.

Although it is important to determine whether Atos staff are polite, courteous and accommodating to individuals undergoing the work capability assessment, the most important issue for my constituents is whether Atos gets its assessment right. I suspect that, if the quality survey were completed after the results of the assessment were known, rather than before, the feedback would be substantially different. Will the Minister undertake to consider that issue further, with a view to obtaining a more realistic overview of the claimant’s experience than that currently recorded in the quality survey?

I will conclude by highlighting the case of a constituent that I think best encapsulates all that is wrong with the current system. The Minister is aware of this case, and he was kind enough to meet me last year to discuss it. Nevertheless, I want to put it on the record because, as I said in response to an intervention, I believe that this example is not atypical of many people’s experiences.

My constituent, who wishes to retain anonymity, suffers from Parkinson’s disease. I am no expert on that condition, and I possess only a rudimentary level of knowledge about the illness. I do know, however, that it is an incurable progressive condition, as I am sure Members are all aware. Like many sufferers of Parkinson’s disease, my constituent has good days and bad days. His condition may deteriorate rapidly, or it may get worse over a long period of time—we do not know. We do know, however, that he will not get better.

Despite his condition, my constituent has undergone two work capability assessments, and on both occasions he was found to be fit for work. On both occasions he appealed the decision and was successful in that appeal. Late last year, however, he was called for yet another assessment. Where is the sense in that? If my constituent has an incurable progressive condition and was found to be unfit for work after his first appeal, why was he called in for a second assessment? If he was found to be unfit for work after the second appeal, why was he called for a third assessment?

I understand the need for the continuous assessment of people with conditions that may improve and mean that the individual in question can return to work, and I accept the principle of regular assessment. Being in receipt of employment and support allowance should not automatically mean that someone is on benefits for life. Nevertheless, common sense must be applied. If an individual is never going to get better, why should we reassess them? It is a waste of my constituent’s time and energy—it takes a considerable amount of energy to get to the assessment and the appeals—and it is a waste of taxpayers’ funds. As we know, the cost to the tribunal service of dealing with appeals is projected to be £60 million this year.

Think of the amount of money that has been spent on that one case. There was the original ESA50 limited capability for work questionnaire, the first assessment and the decision maker’s process after the initial WCA, followed by the first appeal and the necessary post-appeal work that must be carried out by Jobcentre Plus staff. That process was repeated a second—now third—time, and will no doubt be repeated again and again until the Government decide to stop the revolving door of continuous assessment and appeal processes that many people have to undergo. Some people are not going to get better or be any fitter for work after the third assessment than they were after the first or second.

As I have made clear, I believe the work capability assessment to be right in principle but wrong in practice. Although its flaws were clear and highlighted by the pilot process and the Work and Pensions Committee report, the Government went ahead with the nationwide roll-out. I have put a number of questions to the Minister, and I am sure we will hear from many other hon. Members. He should address those questions and not seek to avoid them by laying the blame elsewhere. My constituents, and many people in the country, do not object to an assessment to determine someone’s fitness to work. They do, however, object to a system that seems more concerned with hounding those who cannot work, rather than helping those who want to work.

--- Later in debate ---

[Chris Grayling]

I will not take interventions, because I have only five minutes and must get through a lot.

We have also tried to make the process more humane. People now get phone calls instead of the generated, standard letters that I regard as impersonal and inhuman. All our measures are part of a process of change that I hope will make a real difference to individuals’ experiences—and it is. Indeed, in his second report, Professor Harrington praises those involved in the process for creating a system that he, as an independent figure, regards as much improved.

As constituency MPs, we will always have people coming to our doors saying, “I am being done wrong by,” because sometimes, in an imperfect system, we will not have got it right. Equally, however, some people will still think that we have done wrong by them, but three years later, when they are back in work, they will say that it was the best thing that ever happened to them.

About a month ago, I sat with a woman in a Work programme centre who said that she had been off work with chronic depression for 13 years. She told me that she had arrived on her first day in the Work programme and said, “I can’t possibly work. This is ridiculous. I don’t know why I am here. I am being traduced.” A month later, she was doing voluntary work in a charity shop, applying for jobs and beginning to say, “Actually, this is good.” We are taking people through a difficult period in their lives.

I said “rubbish” to the final comment made by the hon. Member for Rutherglen and Hamilton West not because he is not raising genuine issues—although I hope that I have explained their context—but because the system is not about forcing people into work. It is about finding the right number of people whom we can help into work. The alternative is to leave them on benefits for the rest of their lives, doing nothing. I do not believe that they benefit from that.

[Tom Greatrex]

I was making the point that, given the lack of confidence in the system, many people feel as though they are being hounded rather than helped. That is the crucial matter that must be addressed in the coming period.

[Chris Grayling]

I accept that, but I genuinely hope that hon. Members will take note of what I said about the time lines and the changes that we have introduced. Professor Harrington said of the concerns highlighted in the Citizens Advice report to which hon. Members referred, “This happened before my changes.” I hope that we can send the message that the system is changing and improving and that we are making genuine efforts and will continue to do so. That is why we changed the guidance in November. It is a process of continuous improvement. We want to get it right as far as we possibly can.

I shall try to answer one or two specific questions before I finish. On audio recording, we will offer everyone who wants it the opportunity to have their session recorded. We decided not to implement universal recording because, based on the trial experience, people did not want it. Few people wanted their sessions recorded, and some said that they definitely did not. We decided therefore to offer recording as an option to those who want it. That seems entirely sensible.

Contact between Atos health care professionals and decision makers will be done by telephone. What matters is not the contact between a single person and a block of decision makers, but trying to phone up the decision maker themselves. On capacity issues, as we stand here today, the incapacity benefit reassessment is on time. New claims for ESA have fallen a bit behind, mostly because of the introduction of the personalised statement following Professor Harrington’s report. We discovered in the first few weeks that it took health care professionals much longer to complete the statement than expected, so the number of completed assessments dropped. That has changed. They have caught up again, and we are chasing through to clear the backlog, as we are doing with the appeals backlog that we inherited.

Finally, the right hon. Member for East Ham asked about the Work programme. Incapacity benefit reassessments are progressing according to time. The biggest impact on numbers in the programme has been created by the different mix of people coming through and the bigger support group. I am quite relaxed about having a bigger support group, because if we need to provide long-term unconditional support to a larger group of people than we had expected, it shows that we are making a genuine effort to get it right and are being sensitive to the needs of people with disabilities. We want to help them into work, but we want to do it in the right way.