Benefits (Terminally Ill Patients)

Debate between Tom Greatrex and Meg Hillier

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.

Work Capability Assessments

Debate between Tom Greatrex and Meg Hillier

Wednesday 1st February 2012 Westminster Hall

[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?