Atos Healthcare

Tom Greatrex Excerpts

Tuesday 4th September 2012 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mrs Riordan.

I am pleased that the Minister of State, Department for Work and Pensions (Chris Grayling) is here. I am not sure whether this will be his valedictory performance in that role, but I saw pictures of him going into Downing street earlier, and if he has been promoted to the post of Secretary of State for Justice, I would like to be the first to congratulate him. I remind him, however, that in that post he will be responsible for the tribunals service, which deals with appeals relating to the work capability assessment, so he will not completely escape responsibility for some issues that will be raised this morning.

I am conscious of the number of people present for this debate, which highlights the fact that although hon. Members may be consumed by events in and around Downing street today, many people outside are concerned about aspects of the work capability assessment and employment support allowance. I am sure that hon. Members will want to reflect those views and with that in mind, I shall endeavour to be brief. I shall take only a few interventions, to allow more Members to contribute.

There are three points on which we probably all agree: first, there are benefits in working. I have seen many of my constituents—although it is harder to do so now than it was a few years ago—return to work after long periods of unemployment. As well as any material benefits, the positive impact on their health and well-being is obvious. We should all encourage as many people as possible to work and get back into work if they have not worked for some time. Secondly, as most of us would acknowledge, helping and supporting those who have not worked for a long time can be difficult and time-consuming. It needs to be done sensitively, so that people feel helped and not as though they are being punished. Thirdly, although not everybody completely accepts this point, many feel that an assessment for those who rely on sickness and disability benefit is useful and appropriate. That was the envisaged purpose of ESA: to support those who can work into work, as well as those who sadly will never be able to work again.

Six months ago, I was fortunate enough to secure a debate on this issue in this Chamber. At that time, the Minister confidently predicted that the performance and situation would massively improve and some changes that had been made had not yet fed through. Six months later, I suggest to the Minister that the number of people present today indicates that very real concerns and problems remain, many of which are sure to be reflected during the debate.

In our previous debate, I focused on the experiences of constituents who had undergone the assessment. I told the story of a constituent trapped in the system who went through an assessment, a successful appeal, a reassessment, followed by another successful appeal and then another reassessment. For too many people, that remains the experience across the country. The Minister and whoever his successor will be need to look carefully at that issue and address it. I have spoken with many constituents who would love to go out to work, but it is not possible to do so because they suffer from a disability or a chronic condition, and I am sure that many Members in the Chamber will want to speak up for such people.

[Jack Dromey (Birmingham, Erdington) (Lab)]

I congratulate my hon. Friend on securing this debate on a vital public concern. He has spoken of his own constituents. In my constituency, Paul Turner, a manager and proud family man, contracted a serious heart disease. He was off work and although desperate to work, could not do so. However, he was told that he was fit for work and was denied benefit. As his wife says, he went into serious decline and died only weeks later. In the work capability assessment, his heart was not tested. Does that not demonstrate how fundamentally flawed the assessment process and its conduct by Atos are? Does my hon. Friend not agree that it is absolutely wrong in a case such as that for the Minister to refuse to refer it to the serious case review, so that profound lessons can be learned? Never again should anyone be treated in the way that Mr Turner was.

[Tom Greatrex]

My hon. Friend makes a powerful point. A number of cases could be cited that indicate the lack of comprehensiveness in the assessment process and the failure sometimes to incorporate other evidence to ensure that not as many people are wrongly assessed.

I want to concentrate on some contractual issues this morning, and I am sure that others, like my hon. Friend, will make comments about individual cases to illustrate those points. The work capability assessment must be tailored in the interests of both the individual and the taxpayer. Unfortunately, both are getting a raw deal from the system. It is true that the work capability assessment was introduced under the previous Government, which is a point that Government Members frequently make, as I am sure that they will today. It is also the case, however, that in late 2010 the contract with Atos Healthcare was amended, extending it to 2015, beyond its original conclusion date of 2012. The work capability assessment was rolled out to millions of people on incapacity benefit under this Government, despite pilot projects in Aberdeen and Burnley highlighting serious concerns. The Minister said during our previous debate—I paraphrase him slightly—that, in his judgment, the Government should get on with that process and try to work on the basis of the expert reviews as they were going on, rather than fixing it in the first place.

[Kevin Brennan (Cardiff West) (Lab)]

My hon. Friend is right to point out that the work capability assessment has been around for some time. For many years, I have been helping my constituent, Mr Robert Shafer, who was the victim of a poor assessment. Is my hon. Friend as concerned as I am that the chief medical officer of Atos is now Professor Michael O’Donnell? He was previously employed as chief medical officer by the American insurance company, Unum, which was described by the insurance commissioner for California, John Garamendi, as an “outlaw company” that has operated in an unlawful fashion for many years, running claims denial factories? Is that the kind of person that the Government should allow to be in charge of a work capability assessment system?

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[Tom Greatrex]

My hon. Friend makes an important point about the organisation of the company contracted to undertake that work on behalf of the Department for Work and Pensions. I shall go on to make points relating to other legitimate concerns about Atos Healthcare that need to be addressed. In many respects, given that the cost of appeals has more than doubled in two years, from £25 million in 2009-10 to £60 million in 2011-12, the performance by Atos Healthcare has, in many ways, been extraordinarily poor.

[Wayne David (Caerphilly) (Lab)]

On appeals, does the fact that nearly 40% of the people who are initially unsuccessful are then successful on appeal not demonstrate a fundamental flaw in the work capability assessment process?

[Tom Greatrex]

The level of appeals and successful appeals indicates that, although no process is 100% accurate all the time, many decisions are wrong and need to be corrected through the tribunals service. No one should forget, however, that that process can take six to nine months because of the backlog of appeals. During that time, people suffer from severe anxiety and concern about their fate, so my hon. Friend makes an important point.

[Joan Walley (Stoke-on-Trent North) (Lab)]

This issue affects us all, in all our constituencies. The whole test is deeply flawed. Does my hon. Friend agree that, in the short term, we can advise our constituents that when they are undergoing the test, they can request that it be videoed, which would at least assist with further appeals? It has just been pointed out how much the appeals cost the taxpayer, so the Government are paying twice over for what is essentially a flawed capacity assessment.

[Tom Greatrex]

I thank my hon. Friend for her intervention. I am not unaware of what Atos says to people who seek to video their assessment, because cases have been highlighted to me in which people have asked for their assessments to be recorded. In the previous debate, the Minister said that if anyone wanted to have their assessment recorded, they could have it recorded, but that has not been the case in many instances and people are refused permission to record the assessment themselves. I would be interested to hear the Minister’s response to that point.

[Richard Burden (Birmingham, Northfield) (Lab)]

I am grateful to my hon. Friend for giving way again; he is very generous. He has hit on an important point about the interface between the appeal problems and Atos’s work. Is it not true that there is a weird revolving door now? People get an assessment, question it and wait ages for the appeal. They may or may not win the appeal, but by the time the appeal comes up, they have had another assessment and therefore they go through a revolving door of losing benefits. Something is fundamentally wrong and unfair.

[Tom Greatrex]

My hon. Friend touches on a very important point. When I raised it with the Minister at recent DWP questions, he indicated that, finally, some of the information coming back from the tribunals service would go to DWP decision makers, so that they were better informed. I will make this point now, so that the Minister can, I hope, respond to it. That started to happen in July. I want to raise the issue of the status of those reports and what impact they will have on people being called for further assessments. In particular, some tribunals now have a section at the end of that information that suggests that that particular applicant should not be reassessed within 12 months or 24 months. Is that something that the DWP is taking into account and appreciating before it calls people back? I ask that because my hon. Friend the Member for Birmingham, Northfield (Richard Burden) is exactly right: there are many cases of people who have been caught in this process, which is no good for their health and no good for taxpayers, because we end up paying again and again over time.

[Several hon. Members]

rose—

[Tom Greatrex]

I will take one more intervention. I apologise to everyone else, but I want to leave time for other hon. Members to make contributions. I give way to my hon. Friend the Member for Airdrie and Shotts (Pamela Nash).

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

On the point about recording assessments, a constituent of mine was told recently that they could record the assessment, but only if they paid for a private, independent company to come in and do it. Obviously, someone who is living on benefits cannot afford that. I wrote to the Minister at the time about the issue. I wonder whether he can deal with the recording of assessments in his closing remarks.

[Tom Greatrex]

I thank my hon. Friend for her intervention. She has made a point to which I hope the Minister will be able to respond.

I will attempt to move on. Back in February, I wrote to the National Audit Office to outline concerns about the contract between Atos Healthcare and the DWP. The correspondence centred on two issues: first, a lack of efficiency in the use of public funds, to which I have referred, and, secondly, a lack of accountability inherent in the disbursement of those public funds. As the recent House of Commons Library note and many of the figures that I have received as answers to parliamentary questions over the past 18 months or so have confirmed, and as my hon. Friend the Member for Caerphilly (Wayne David) reflected, 41% of those found fit for work appeal the decision and 38% have their appeal upheld. For those who seek the advice and support of professional advocacy groups such as Citizens Advice, the appeal success rate is closer to 70%. Just last week, Kent’s largest citizens advice bureau indicated an appeal success rate of 95%.

The impact of what is happening is twofold. First, too many sick and disabled people are being found fit for work when they are not. They become entangled in a lengthy appeal process that can occupy up to nine months of their time. In many cases, even when the appeal is successful, the individual is placed in the work-related activity group and then they have to begin the whole process anew.

[Ann McKechin (Glasgow North) (Lab)]

Will my hon. Friend give way?

--- Later in debate ---

[Tom Greatrex]

I will not, because I need to make progress. I apologise to my hon. Friend.

The second impact of the high appeal success rate is cost. The cost to the public purse from appeals relating to the WCA was £60 million in 2011-12. That figure has more than doubled since 2009-10. It is almost 50% of the total yearly value of the Government’s contract with Atos Healthcare to carry out the assessments in the first place. In effect, taxpayers are paying for the process not to work, and then to correct it. Given the unprecedented pressures on the public purse, it beggars belief that the Government are apparently content to sit back and do very little to rectify that situation.

In oral evidence to the Work and Pensions Committee in June 2011, the Minister claimed that if the migration of those on incapacity benefit to ESA was successful, it would save money. He said that the aim is not a

“savings measure—it is not a financially based exercise, although clearly if we succeed it will save money”.

The Minister appeared to accept that an indicator of success was saving money, so does he accept that the significant increase in costs associated with the number of decisions being appealed—and being successfully appealed—shows that, on that measure, the Government have failed?

One measure that I and many others have been questioning is the imposition of financial penalties on Atos Healthcare to compensate for poor performance. In February, in response to my written question on whether the Government had considered imposing such sanctions, the Minister appeared to absolve Atos of the blame for the number of decisions overturned on appeal by saying that:

“it would not be appropriate to impose financial penalties on Atos to reflect the number of work capability assessments which are overturned on appeal.”—[Official Report, 22 February 2012; Vol. 540, c. 852W.]

I tried again in July by asking for a note of when penalties had been imposed and what their total value was, but that time, rather than absolving Atos of blame, he decided to protect the company’s commercial interests, replying with the frequent defence of “commercial sensitivity” as the reason for withholding that information. I find it difficult to understand how commercial sensitivity comes into play when we are talking about a single company that is paid from the public purse to carry out an exclusively public function on behalf of a Department. Transparency would help to ensure that there could be confidence in the system and to highlight where performance was not being properly managed. It is important that the Minister seeks to address that.

It was not until the NAO responded to me last month that some light was shed on the issue:

“We do not consider that the current contractual targets are sufficiently challenging, and in our view this allows the contractor to deliver a significant number of assessments before financial penalties become due.”

It continued:

“Our review also concluded that the Department has not sought adequate financial redress for contractor underperformance.”

One of the most concerning revelations from the NAO was that in only 10% of the cases in which financial penalties could have been imposed did the Government do so. That is astonishing. Given that the Government and the Minister quite frequently comment on the importance of value for money for the taxpayer—in some respects, I agree with that—it beggars belief that when there are opportunities to put that into practice, the Government have done so in only one in 10 cases.

I quote:

“In these times of tight budgets, we need to make sure the money we do spend is better spent. If we don’t we are failing disabled people and their families.”

Those were the words of the Prime Minister in 2009 at a conference on autism. In that same speech, the then Leader of the Opposition cited a NAO report that examined value for taxpayer money in relation to autism. I am sure that, even given his elevation today, the irony is not lost on the Minister.

There are many questions that the Minister must answer to account for the failure properly to manage the contract with Atos Healthcare. Why did he impose financial penalties on only 10% of the occasions on which they could have been triggered? What was the value of compensation clawed back from Atos Healthcare to reflect that poor performance, and what was that as a percentage of the cost to the public purse for the original contract and appeals? Does he agree with the NAO that targets that trigger financial penalties are not sufficiently challenging? What are the key performance indicators that the NAO described as insufficiently challenging? That is a particularly important issue.

On a number of occasions, I have attempted to gain clarity on what is expected of Atos in relation to customer service, the number of assessments conducted, the number of people found fit for work, targets, statistical norms and many other issues. The Minister has refused to be fully transparent, releasing a very limited excerpt from the medical services agreement with Atos that relates only to waiting times. As I said, maximum transparency is important to enable people here to hold the Government properly to account, and to hold Atos Healthcare, through the Department for Work and Pensions, properly to account for the work that it is undertaking in a very important area.

The NAO was also scathing about the Government’s failure properly to monitor the performance of Atos. According to the NAO, there is

“Limited routine validation of information provided by Atos Healthcare”.

It went on to recommend that

“the Department develop processes to validate key performance information supplied by Atos Healthcare.”

Back in February, in the previous debate on the issue, the Minister stated, with a certain degree of confidence:

“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…We discovered in the first few weeks that it took health care professionals…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”.—[Official Report, 1 February 2012; Vol. 539, c. 292WH.]

Unfortunately, the evidence does not bear out that assessment.

The target waiting time from when the ESA50 form is issued to the claimant to when Atos Healthcare completes the work capability assessment and hands the case back to the DWP is 35 working days—seven weeks. Between September 2009 and August 2010, the target was met with a clearance rate of 33 days, yet in less than two years, not only has the target not been met by an astonishing margin, but the time sick and disabled people have to wait for their assessment has risen by 85% to 61 working days, or more than 12 full weeks.

More than 20,000 people are waiting more than 13 weeks for a work capability assessment. The reason the Minister gave was:

“Atos Healthcare’s ability to deliver a service within the AACT was also impacted by the service volumes for this period which were significantly above departmental forecasts; in addition Atos had recruitment demands/challenges. These issues…resulted in an increase in the AACT.”—[Official Report, 9 July 2012; Vol. 548, c. 51W.]

Atos Healthcare receives more than £110 million a year to deliver a contract, but is unable to meet its recruitment needs to deliver it properly. That, at best, is an example of the underperformance and the level of failure due to which the Government should ensure that financial penalties are brought against Atos Healthcare. Such contractual failure feeds directly into the experiences that I am sure we will hear about in the remainder of the debate. Many people across the country have found themselves waiting an excessive time for their assessment. They are under pressure and feel hounded, and they may well wait a significant period for the appeal to follow. A degree of the chaos in the system is caused by the Government’s decisions and the failure to hold Atos properly to account.

This is not the first time that recruitment challenges at Atos have been highlighted as reason for failure. In December 2011, the Minister advised that a key Harrington recommendation would not be implemented beyond the pilot stage due to capacity pressures at Atos. In less than a year, the Government have twice cited the failure of Atos to recruit enough staff as the reason why those undergoing the WCA are being short changed, which gives rise to a question: if the Government are content to blame Atos, why has the Minister spectacularly failed to do anything about it? Why, in his answer to written questions, does he lambast Atos when waiting times increase, yet sit on his hands when it comes to making the company pay financially for its underperformance?

In 2010, the average WCA customer journey was 36 working days. That rose to 44 working days in the first half of 2011, and increased still further to 53 working days in the second half of 2011. Unfortunately, 2012 brought more misery for ESA claimants, as between January and May, the average customer journey increased to 64 working days, or just under 13 weeks. The Minister inherited 36 working days and transformed it into 64—an increase of 78%. It might seem that I am talking about the dry detail of contractual issues, but we see the defects at the heart of the process—the failure of the management of the DWP and the failure of delivery at Atos—reflected in the experiences of many people we represent.

I want to say a few words about the award of the £400 million contract for the personal independence payment in many parts of the UK to Atos Healthcare. A further criticism in the NAO review, which interestingly enough was dated the same day as the announcement of the PIP framework agreement, was about medical services contracting. The NAO stated specifically in relation to the PIP procurement process:

“Our review of existing arrangements concluded that the Department needed to make changes to secure effective leverage over future medical services contracts...we have recommended that the Department focus on reducing the barriers for new suppliers to making a sustainable entry to the medical services market, in particular addressing the current risk that a single incumbent supplier has significant cost advantage which makes delivery of a level playing field in the market more challenging”.

The NAO went on to lament the DWP’s

“dependence on a sole national supplier”

that has

“limited opportunities for routine assessment of value for money, for exercising contractual leverage and for wider market development.”

Like many Members in the Chamber who represent constituencies within the areas for which Atos Healthcare will undertake the PIP assessment process, I received a letter from Atos confirming that it had been successful in securing the contract. It included the chilling phrase that it had won the contract on the basis of its record delivering assessments for the Government over a period of years. This is a serious point, because as the PIP process is established, it is vital that some of the problems encountered in the WCA are not simply repeated. There is concern that there is an increasing risk that that will be exactly the case, given the chosen contractor.

Contractual arrangements, performance measures, penalty clauses, and monitoring and delivery failures are technical, dry and dull matters, especially when contrasted with the sometimes heartbreaking and tragic cases that I have heard about, not only from my constituents, but from many of those who have contacted me prior to the debate. Many of those experiences are due to the flawed delivery of the WCA and the record of Atos Healthcare.

Whoever is the responsible DWP Minister tomorrow afternoon, we need a process that works in the interests of taxpayers, and of individual claimants and applicants. We need a process that is comprehensive enough to encompass complex conditions and that recognises that it is a waste of time and money to keep reassessing people with progressive and incurable conditions, while also recognising the fluctuating nature of many other conditions—that people have good days and bad days. We need a process that appreciates the very difficult challenges of assessing mental health needs and that takes account of expert medical evidence much more fully than the current process, particularly in some of the cases we have heard about. We need a process that does not make blanket assumptions about the time it takes to recover from very serious illnesses, such as cancer, nor imposes blanket conditions as a result. We need a process that helps people who can work and does not hound those who cannot.

[Several hon. Members]

rose—

Oral Answers to Questions

Tom Greatrex Excerpts

Monday 25th June 2012 Commons Chamber

[Chris Grayling]

I absolutely agree with my right hon. Friend. I have made it clear that I would like employers in this country to offer opportunities to local workers, but those workers need to be there—they need to be keen, energetic and wanting that work. I hope and expect that our Work programme providers will provide that energisation.

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

The Minister will know that, as well as the people looking for work following a refusal of appeal, many people win their appeal. Having won an appeal, however, they then have another work capability assessment, but the information that led to their appeal being won is not made available to the people undertaking the second WCA. Will he look at this situation in order to prevent people from going through a cycle of assessment, followed by appeal, followed by assessment?

[Chris Grayling]

The hon. Gentleman will know that the system set up by the previous Labour Government set a prognosis time for an individual—an estimate of how long before they could return to work. It is that, rather than anything else, which guides the timetable for repeat assessments. I have taken steps to stretch that timetable post-appeal, but I do not want to leave people stranded on benefits for the rest of their lives if we can possibly help them find employment.

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[The Parliamentary Under-Secretary of State for Work and Pensions (Maria Miller)]

My hon. Friend is right to raise this issue. However, the Paralympics will give this country a once-in-a-lifetime opportunity for us to showcase the talents of disabled people. I recently had the privilege of speaking to Channel 4 about how it will be covering this event and to meet some of the six disabled people who are now trained commentators who will be showcasing this amazing event.

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

T8. Perhaps my earlier question was not clear, because I did not get a clear answer from the Minister, so I wonder if he could answer my question this time. With the number of people who go through a process of work capability assessment, followed by appeal, followed by assessment again, will he undertake to ensure that the information on which tribunals decide that people are not fit for work is made available to those making the decisions for the following work capability assessment, so that people do not get caught in that cycle?

[Chris Grayling]

Yes, I get what the hon. Gentleman is talking about. We are currently working with the tribunals service to get written decisions passed back to Jobcentre Plus for decision makers. That will be introduced within the next month.

Disability Benefits and Social Care

Tom Greatrex Excerpts

Wednesday 20th June 2012 Commons Chamber

[Maria Miller]

I hope that the hon. Lady will forgive me if I try to make a little more progress, as I know that we want to cover a number of issues in this debate.

These changes have softened the system and made it fairer for people, recognising that many people with a health condition want to work and can do so with the right support. We have asked Professor Harrington to continue to review this process for us and make recommendations, because for too long under the last Government people were written off on benefits.

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

rose—

[Maria Miller]

If the hon. Gentleman could perhaps sit down and let me make some progress, we would be able to talk about the fullness of this debate. That would be a better way of doing it.

At the moment, some 900,000 people have been on incapacity benefit for a decade or more, many of whom will be disabled. This approach is not only unfair and unkind; it is also a waste of people’s potential.

[Tom Greatrex]

Is the Minister aware of the memo, published on The Guardian website this afternoon, from Paul Archer, the head of contact centres, headed “Supporting ESA customers”? It was sent to “all staff in operations” and it states:

“The consequences of getting this wrong can have profound results.

Very sadly, only last week a customer of DWP attempted suicide—said to be a result of receiving a letter informing him that due to the introduction of time-limiting contribution based Employment and Support Allowance for people not in the Support Group, his contribution-based Employment and Support Allowance was going to stop.”

Is it not time that the Minister and her departmental colleagues realised the seriousness of the implications of some of the decisions being taken by her Department and undertook a full inquiry into this incident and all other incidents where the real pressure being put on people is completely unfair?

[Maria Miller]

The hon. Gentleman is absolutely right to be concerned about such a difficult circumstance. I think he would only expect the Department to make sure that staff were handling such cases correctly. Of course every case like that is an absolute tragedy, and we want to make sure that the system works really well for the individuals concerned. I am sure that he will want to applaud the work that the Government are doing to try to make the system better. I repeat that the system we inherited was harsh and difficult, and we have softened that further.

--- Later in debate ---

[Duncan Hames (Chippenham) (LD)]

We have certainly heard strong words in the debate, but a careful study of the motion suggests that it tells us about those areas on which the Opposition agree with the Government. It says that DLA “needs to be reformed” and that the work capability assessment, which was introduced in the final years of the Labour Government, is in “pressing need” of reform. It even suggests that the principle of the closure of Remploy factories is not in dispute, because I thought that the shadow Secretary of State, the right hon. Member for Birmingham, Hodge Hill (Mr Byrne), was asking whether now is the right time. There is also agreement throughout the House about the importance of recognising the contribution made by carers, and I suggest that such recognition is reflected by the £400 million that the Government found to support respite breaks for carers. We should clarify where there are points of disagreement.

All parties can agree that the Government’s aim should be to create a system that ensures that every disabled person is treated with dignity and respect, and that they have access to the services and support that they need to fulfil their potential. That is reflected in the aim in the Government’s business plan, although we do not know what change of approach that represents. Despite difficult economic times, that remains the Government’s intention, and Liberal Democrats have already made a difference to the policies that can help to make that a reality. Although we support a cap on the total amount of benefits that a household can receive, we considered it vital that the cap was set at the right level, to protect those who are unable to work through disability or ill health. That is why Liberal Democrats welcomed the original exemption of DLA from the cap, but pressed further to exempt all those in the support group of employment support allowance as well, to which the Government agreed.

Liberal Democrats in the Lords amended the qualifying periods for the personal independence payment to match the existing qualifying periods for disability living allowance. This should ensure that those who need support up front, perhaps to deal with the costs of a new condition, will get that support quickly. However, the principle remains that personal independence payments are a long-term benefit. On the Floor of the House I repeatedly highlighted a campaign in support of disability charities to get the Government to rethink—and ultimately abandon—the proposal to remove the mobility component from the disability living allowance of local authority-funded care home residents.

There is much on which we have been able to agree, but there is certainly still more work to do, especially on getting the work capability assessment right. Liberal Democrats support the plans of the independent reviewer, Professor Harrington, to develop new, evidence-based descriptors, covering chronic fatigue and pain, which would help better assess those with fluctuating conditions. During the exchanges earlier in the debate, I was amazed at the refusal to acknowledge that the work capability assessment as it was operating at the start of this Government barely two years ago was that created by the Labour Government. It relied too heavily on the contracted-out, face-to-face assessment performed by Atos, with decision makers just rubber-stamping a decision that Atos had made. I therefore welcome the Harrington proposals to give DWP decision makers more flexibility to look at evidence other than the Atos assessment in coming to their decisions.

[Tom Greatrex]

Will the hon. Gentleman give way?

[Duncan Hames]

I will happily give way because I hope we can at least agree that what was put in place by the previous Government was unacceptable and, in the words of the shadow Secretary of State, needed to be adapted.

[Tom Greatrex]

I am sure the hon. Gentleman will take the opportunity to remind the House that after the work of the Select Committee and after the pilot areas had highlighted a number of flaws in the system, it was his Government who put in place the migration of people on incapacity benefit to ESA through the work capability assessment. If the Government were so concerned about getting it right, perhaps it would have been a better course to make the changes to the system before starting the migration.

[Duncan Hames]

I have read speeches in Hansard from before I was elected when colleagues of mine pleaded with the previous Government to make changes to the work capability assessment that they were introducing. On the timing of those changes, they should have been made even before the present Government came to office.

I turn to the matter of Remploy. [Interruption.] Changes are being made now. It is worth noting—

--- Later in debate ---

[Tom Greatrex]

I am glad to have the opportunity to speak in this important debate. I congratulate my right hon. Friend the Member for Birmingham, Hodge Hill (Mr Byrne) on securing it as part of the Opposition day. If I had more time, there are many topics in the motion on which I would like to speak, but I shall limit my comments to the work capability assessment and, to some extent, follow on from the hon. Member for Chippenham (Duncan Hames) about some aspects.

The work capability assessment is a fundamentally important issue and I shall speak about some of the difficulties that I have encountered in trying to uncover the detail of the contractual conditions and information about the relationship between the Department for Work and Pensions and Atos Healthcare. I welcome the part of the motion that refers to the WCA. Members are aware of many of the concerns surrounding the work capability assessment. In an earlier intervention I made the point about the migration, so I will not repeat it. That, to me, sums up the fact that if the Government wanted to get it right, they would have done so before rolling it out further, and they would have applied the lessons from the pilot areas, Aberdeen and Burnley, and from the very good report from the Select Committee that followed from that.

All of us have many constituency cases to which we could refer. I have had a number, including a constituent with Parkinson’s disease who was assessed as fit for work, went through an appeal, won the appeal—as we heard, 40% of people do—and almost immediately underwent another assessment, was assessed as fit for work, went through another appeal and underwent a third assessment. People with fluctuating and other conditions are not necessarily well served by the work capability assessment. Parkinson’s, as Members know, is a progressive and incurable condition. Although people with Parkinson’s may have good days and bad days, in the case of my constituent he could not come to see me; I went to see him, and it was obvious that he was in severe discomfort and barely able to answer the door to let me into his flat.

To go through a process, win an appeal, be assessed yet again, and then repeat that whole sequence—this crosses over the period of the implementation of some of the changes recommended in the first Harrington report—strikes me as a waste of time and money, quite apart from the stress and anxiety that it causes individuals. Someone who has that condition is not going to get better. I am not saying that everybody with Parkinson’s is unable to work. Many people with Parkinson’s do, but once they get to a certain stage, they are not going to get better. To go through such stress and anxiety as they go round and round in the system does not help anybody get back into work, which is the stated purpose of the work capability assessment.

I support the work capability assessment and I think it is the right thing to do. Many of my constituents who have encountered problems have said that they object not to the assessment, but to the way in which that assessment is carried out. I want to make a few points about the contract between the DWP and Atos Healthcare. I know that I have made a thorough nuisance of myself to Ministers by tabling about 200 written questions about various aspects of that. I have done so because it is very hard to get to the detail. Although the high level contract has been published, every time I ask questions about some of the performance indicators, I get the blanket answer, “We cannot disclose that information for commercial reasons.”

In February this year a BBC Radio 4 programme uncovered the fact that there are potentially financial penalties for Atos within some of the conditions of the contract, yet I cannot get to the detail of those conditions. Some £110 million is being spent in carrying out the assessments, which lead to a huge number of appeals. Those are adding to the cost because the appeals are referred to the tribunals service, extra judges are being taken on and tribunals are being kept open at the weekend. The additional cost for this year will be £50 million to £60 million to get right what Atos has got wrong. Why is it in the interests of the public purse to pay that money in effect twice to get the right decision? I understand and will always accept that there will be decisions that are not necessarily right and that there needs to be an appeals process, but that volume of appeals in the system suggests that there is something wrong.

Why is Atos not being penalised through its contract for getting so many decisions wrong, because the decisions, although made by the decisions makers, are based on the assessment, and in many cases almost completely on them, and so we go round and round in this system? Why is it still the case that—perhaps the Minister can answer this point—after someone goes through an appeal and has another assessment, the information that the tribunal has to make its decision is not available for the next round of assessment? If this was actually about being fair, equitable and helping people, surely that information should be available so that those decisions are better informed.

I think that the root of the problems with the work capability assessment is the contract and the way the assessment operates. It is a great shame that this third report will be Malcolm Harrington’s last and that there will be someone else for the next two years. Perhaps the Minister could explain why that is the case and who will replace him. I have met him and understand that he has had some frustrations in getting some of the detail on the issues. He will be coming to Scotland in the near future to meet the citizens advice bureau in my constituency and understand some of the real issues. The Government must get this right. We are not against people being assessed, but they should be helped into work, not hounded.

Oral Answers to Questions

Tom Greatrex Excerpts

Monday 23rd April 2012 Commons Chamber

[Chris Grayling]

I wholeheartedly agree with my hon. Friend. The tide of bureaucracy we have seen in recent years has hindered business and affected employment. My view is that the EU should focus on measures that create jobs, rather than hindering the creation of jobs. That is of fundamental importance and I can assure him that I will fight that battle extremely vigorously in Brussels.

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

The Health and Safety Executive has recently concluded its consultation on charging business for some of its services. Will it be able to keep the income brought in through that process or will it go straight into the Treasury?

[Chris Grayling]

The actual process is that all moneys raised in such a way go to the Treasury first, but financial agreement has been reached between the Treasury and the HSE, so that appropriate amounts of money are passed on to the HSE so that it can carry out that regime as intended.

--- Later in debate ---

[Mr Speaker]

Well, that exchange was worth waiting for, I am sure the House will agree. I thank both Members.

Topical Questions

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

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Work and Pensions (Mr Iain Duncan Smith)]

In recent weeks we have published new figures on the incapacity benefit reassessment programme, so I thought it would be helpful to the House if I just reminded Members of the figures. Throughout Great Britain as a whole, some 37% of people have been found fit for work, with another 34% expected to be able to work in the future, with the right support. These figures show that the programme is working.

[Tom Greatrex]

Does any Minister think it appropriate that, while undertaking a contract on behalf of the Secretary of State’s Department, Atos Healthcare, first, published misleading information on its website; secondly, refused to comply with the Advertising Standards Authority inquiry into that information; and, thirdly, failed to correct it until alerted to do so by the media last week—several weeks after the compliance notice was issued? Do they think that that is acceptable for an agency working on behalf of the Government?

[The Minister of State, Department for Work and Pensions (Chris Grayling)]

We always discuss issues such as that one very carefully with our subcontractors, but I do not believe that it affects the professionalism of the health care professionals who are carrying out the work on our behalf. Many are doing a very difficult job in challenging circumstances—but doing the best for people who claim incapacity benefit and who could have a better future.

Employment Support

Tom Greatrex Excerpts

Wednesday 7th March 2012 Commons Chamber

[Maria Miller]

I can absolutely assure my hon. Friend that the individuals who are affected by these announcements will receive unprecedented levels of support from the £8 million package. We want to ensure that each individual is given the kind of personalised package of support that they have not received in the past, to enable them to make the transition from segregated employment to mainstream employment. We want to do as much as we can to improve the opportunities for more disabled people to live independent lives.

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

If the Minister has read the responses to the consultation, she will be aware that, following the last round of voluntary redundancies, a large number of people were still not in work 18 months later. Why does she think it is going to be different this time, when she is proposing compulsory redundancies at a time that she has acknowledged to be one of economic difficulty?

[Maria Miller]

The hon. Gentleman might not have heard me say earlier that, in the last major round of redundancies, which took place under the Labour Government in 2008, no process was put in place to track the progress of individuals who were offered support. Indeed, we found that some 40% of the individuals involved took retirement or early retirement. I want to ensure that people have the right support, and that they can see that there is an opportunity to move forward. Now, more than ever, it is important that we get this right. The last Government ducked these decisions; they did not take the difficult decisions and they did nothing to ensure that disabled people could get the job opportunities that they needed.

Oral Answers to Questions

Tom Greatrex Excerpts

Monday 5th March 2012 Commons Chamber

[Chris Grayling]

This is one area where we have worked very hard to secure a change. A large amount of new evidence was indeed appearing only at the appeal stage and that was one of the key things that Professor Harrington suggested we address. We are now bringing in medical evidence much earlier—at the start of the process, when the decisions are taken or when a reconsideration is taking place in Jobcentre Plus. There are now few circumstances in which new evidence appears at the appeal stage, and that is really important.

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

I am sure that the Minister will be aware of the research undertaken by Citizens Advice Scotland for its report “From pillar to post”, which highlighted some issues that Professor Harrington should be considering in his further reports. Will the Minister meet me and representatives of Citizens Advice Scotland to discuss those concerns so that he can discuss them with Professor Harrington before he undertakes his third review?

[Chris Grayling]

I have many meetings with people involved in these matters. I suggest that it is better for the hon. Gentleman and Citizens Advice Scotland to meet Professor Harrington directly to raise those concerns, rather than for me to be a middleman. We listen carefully to the recommendations he makes, and I would be happy to arrange that meeting for the hon. Gentleman.

Benefits (Terminally Ill Patients)

Tom Greatrex Excerpts

Thursday 9th February 2012 Commons Chamber

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

As MP for Hackney South and Shoreditch, I am privileged to represent a number of organisations that are national leaders in their field, one of which is St Joseph’s hospice, which, founded by the Sisters of Charity, has for 109 years provided support for east enders who are dying.

St Joseph’s works with patients to help support them in their final months of life. It offers end-of-life care in its hospice and day hospice, and at home, for terminally ill people, their families and carers. It has a great deal of experience in ensuring that patients get the benefits to which they are entitled.

St Joseph’s has recently alerted me to serious problems with the administration of benefits for people who have been diagnosed with a terminal illness. Hackney citizens advice is also helping a number of people who are diagnosed as terminally ill who are not receiving consistent support and advice when applying for benefits, particularly employment support allowance.

I want to outline the scale of the issue; what is supposed to happen when someone who is terminally ill claims benefits; and the experience of national and local providers and individuals. If I may, I also want to suggest to the Minister some ways in which the situation can be improved.

Nationally, Macmillan Cancer Support and Citizens Advice work together to support cancer patients with benefits and debt advice. From March 2007 to March 2011, they helped more than 39,000 cancer patients with over 190,000 issues. Out of those 190,000 issues, 78% were related to welfare benefits in general, with employment support allowance cases totalling 10,659, or around 8% of cases.

Over the same period, Citizens Advice and Macmillan caseworkers gained more than £77 million for their clients. More than £71 million of that was through ensuring that clients received all the benefits to which they were entitled. Behind those big numbers are vital payments to families of people who are dying and unable to support themselves financially without the support of the state.

Let me explain to Members of the House who may not be aware how the system of claiming is supposed to work. To be “terminally ill” in order to qualify for benefits, a person must have a progressive disease and their death must be reasonably expected within six months. That is certified by a general practitioner or specialist using a medical report called a DS1500. Once someone is given a DS1500 form, they automatically qualify for disability living allowance at the higher rate.

Employment support allowance is the benefit for people under 65 who are unable to work because of their illness. Under special rules, people who are terminally ill and not already receiving one of those benefits are entitled to swift access at the very highest level of support from one of those options. Some who are still working will qualify for both, but not necessarily at the same time.

Macmillan Cancer Support tells me that in its experience nationally, the system for disability living allowance has worked well. The disability and carers service is able to fast-track payments and usually does so. The service is well attuned to the needs of someone with a terminal illness. However, when it comes to employment support allowance the picture is different. To claim for ESA, the person must advise the jobcentre personally that they are terminally ill. In some cases, patients are not aware of their prognosis; in others, they are too ill to advise their jobcentre. Why, therefore, can local jobcentres not just accept the DS1500 form from a doctor, welfare adviser or relative as proof of the right to ESA, as can be done with DLA? Why can a check not be done on the DLA database by the assessor from the Department?

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

My hon. Friend is setting out the situation powerfully and clearly. My constituent Mr McGowan, of Blantyre in Lanarkshire, is in the latter stages of his life. He has a terminal illness, severe dementia, multiple sclerosis and Parkinson’s disease, he is bedridden and he cannot even swallow. He recently received a standard letter from the Department for Work and Pensions asking him to get in touch so that he could be given guidance about how to get back to work. Given that the DWP knows all the people who are terminally ill, because they have filled in the DS1500 form, is it not irresponsible and distasteful, as well as deeply upsetting for those concerned and the relatives looking after them, for the DWP to send such standard letters, when the data already exist, and people know they should not be in that position?

[Meg Hillier]

I completely agree, and it would be simple to solve the problem. Simply sharing the data would mean that individuals and their families do not have to go through the distress that such letters can cause.

There are times, of course, when a patient who is diagnosed continues to receive income from their employer. That can mean that they do not need to claim ESA until months later, when their paid work stops. They can have their DS1500, but by the time they stop their paid work, it will be out of date. As we know, people have been asked to get an up-to-date form from their doctor.

Macmillan tells me that there have, unfortunately, been cases where jobcentre staff, on seeing the form or requesting it, have disclosed to a terminally ill patient their prognosis. Imagine someone’s shock at learning they are going to die from a member of staff at the jobcentre or from a stranger over the phone. That underlines why the support needs to be particularly sensitive for people who are dying.

Recently, there has been a serious backlog of claims. St Joseph’s has had patients who have died while waiting for their benefits claims to be assessed. I support calls by St Joseph’s and others for the Department to introduce a fast-track approach for end-of-life patients, as with DLA.

Macmillan operates a national helpline and tells me that the situation varies across the country. Some jobcentres say the patient has to make a claim themselves, and some say that is not necessary to start a claim. That variation suggests that, with some focus, the problem could be sorted. I put it to the Minister that we need a step change in how the service is delivered for those who are terminally ill.

The Minister will have been briefed about the guidance that he and his ministerial colleagues have issued to workers on the front line. Whatever the edicts of Whitehall, my concern is that his guidance is not fully understood or is not being followed at a local level. The human impact is immense, and I hope he shares my serious concerns.

--- Later in debate ---

[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.

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.

Oral Answers to Questions

Tom Greatrex Excerpts

Monday 28th November 2011 Commons Chamber

[Maria Miller]

I thank my hon. Friend for his assiduous attention to this issue. We are considering very carefully Lord Low’s extremely helpful report and will come forward soon with our final response.

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

A constituent of mine, Abigail McGhee, was engaged to, and living with, the father of her two young children when he sadly died. Her application for widowed parent’s allowance was declined on that basis. Will the Minister reconsider the application of this benefit for people who find themselves in that sad position?

[Mr Duncan Smith]

Yes, I will, and if the hon. Gentleman would like to send me the details of that case, I will pay particular attention to it.

Oral Answers to Questions

Tom Greatrex Excerpts

Monday 24th October 2011 Commons Chamber

[Steve Webb]

I congratulate the hon. Gentleman on his new role in the House. I much enjoyed his attempt to persuade the House last week that £11 billion was not very much if we divided it by 10 and by the national debt. In answer to his question about auto-enrolment, I can assure him that 2012 goes ahead as planned, as my right hon. Friend the Secretary of State said at the Dispatch Box last week.

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

11. What assessment he has made of progress towards implementation of the recommendations of the Harrington review of the work capability assessment.

[The Minister of State, Department for Work and Pensions (Chris Grayling)]

We took steps earlier this year to ensure that all the recommendations in Professor Harrington’s first report were implemented in time for the start of the national migration from incapacity benefit. I expect to receive Professor Harrington’s second report, telling us how well he thinks we are doing on that front, shortly.

[Tom Greatrex]

Given the Minister’s earlier comments, I am sure that he is well aware of the progressive and incurable nature of Parkinson’s disease. A constituent of mine with Parkinson’s has been called for his third work capability assessment, despite appealing the previous two incorrect decisions by Atos and the decision makers. Will the Minister undertake to meet me and Parkinson’s UK, so that he can understand better how in practice the work capability assessment, rather than helping people who can work, too often hounds those who will not get better?

[Chris Grayling]

The hon. Gentleman has to understand that one of the great failings of our welfare state over the past decade has been that we have left people on the sidelines year after year without checking to see what their condition is or what the potential alternatives are. I am very happy to meet Parkinson’s UK and the hon. Gentleman. I well understand the challenges that the disease presents for those who are unfortunate enough to suffer from it, but we cannot simply go back to a situation in which we leave people year after year without even checking what their condition is.