Health and Disability Reform

Viscount Younger of Leckie Excerpts

Wednesday 1st May 2024 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I will not repeat what the noble Baroness, Lady Sherlock, has just said about the lead-up to the publication of this Green Paper, but it can hardly be described as ideal. When announcing the Green Paper and the reforms to PIP on Monday, the Prime Minister said that something had gone wrong since the pandemic, leading to more people not working because of long-term ill health; he singled out the rise in people unable to work because of mental health conditions. Of course, I agree with helping people to get back into work, where that is possible, and I agree that for some people with mental health problems, it can improve their well-being. What I worry about greatly is putting the spotlight on people with mental health problems in such an unhelpfully divisive and—I agree—stigmatising way.

We need to go back to the root causes here. Can it be any surprise that so many people are claiming sickness and disability benefits when millions are still waiting for NHS treatment, and mental health wait times are through the roof, due to an acute shortage of mental health professionals, including doctors, nurses and counsellors? Does the Minister agree that if the Government are serious about getting people back to work, they need first to reduce waiting times for NHS treatment and tackle the crisis in our mental health services which makes accessing mental health treatment so difficult and protracted?

The Prime Minister also claimed that these changes are about “compassion”, but does this not rather miss the point that most young people claiming PIP are doing so because they have ADHD or autism, rather than anxiety and depression? Last year, 190,000 young people claimed PIP due to autism, ADHD or other learning disabilities, compared to just 129,000 claiming for all other disabilities. Could the Minister explain why, in the announcement of these proposals, there has been such a strong focus on anxiety and depression and how far this is based on the evidence?

I am concerned that potentially stopping cash payments will be seen as an affront to the dignity of benefit recipients. The BBC News website yesterday quoted one 71 year-old recipient, who said that for her PIP is about

“maintaining independence, not being a burden on my family and keeping my dignity”.

It could hardly be said that the reaction from the sector has been favourable. The charity Scope has said that these plans do not fix the underlying issues faced by disabled people. The chief executive of the charity SANE has pointed out that

“mental health problems are often invisible and fluctuate from month to month or day to day, and … assessments for benefits are all too often based on ‘snapshot’ judgments that do not take account of how hidden and disabling mental illness can be”.

Can the Minister say what consultation took place with the mental health sector and those who work closely with people directly affected by these issues prior to the Green Paper being published?

Finally, I turn to a wider issue. The Statement talks about a

“new conversation about how the benefits system can best support people to live full and independent lives”.

I am sure we can all agree with that, but we need to look at these issues in the round. Being able to live independently in the community can often rely on the help and support of unpaid family carers. Does the Minister agree that it is simply unacceptable for over 150,000 unpaid carers to be facing severe financial penalties—pushing many into debt or financial hardship —for often quite unknowingly breaching the earnings limit while caring for a loved one? What urgent steps are the Government taking to stop this outrage, and will they agree to an amnesty while it is being sorted out? If the Minister cannot answer that now—I accept it is not within the immediate focus of this Statement—would he please write to me?

[The Parliamentary Under-Secretary of State, Department for Work and Pensions (Viscount Younger of Leckie) (Con)]

My Lords, I start by thanking the noble Baronesses, Lady Sherlock and Lady Tyler, for their questions; I will do my best to answer them.

Indeed, the Prime Minister did make a speech on 19 April, and I was there in person. He covered a whole range of announcements in the world of welfare. I found it to be a very caring and compassionate speech; that is a really important point to make, because it did not come across in some quarters in the media. On how the Statement was communicated, I will not dwell on that other than to say that both noble Baronesses will know that apologies were given. That is on the record, and I do not think it is right that I should say anything more about that now.

The noble Baroness, Lady Sherlock—and it was alluded to by the noble Baroness, Lady Tyler—spoke strongly about mental health and the link with physical health. I want to make a few remarks about this, because we should see it as a sign of progress that people can talk about mental health more openly. The Government will never dismiss or downplay the conditions that people have; it is precisely because we take mental health so seriously that we need to reform the system. There is no one-size-fits-all approach, but the current system does not reflect that. It is simply wrong to write people off when there is a growing body of evidence that good work can improve mental health.

In terms of the evidence raised by the noble Baroness, Lady Tyler, I visited a jobcentre only this morning and asked various questions of the job coaches. I reassure her, or alert her to the fact, that the evidence is certainly there. I am sure she will know from her own experience there is an increased level of mental ill-health, some of a severe nature. Action must be taken.

But it is more than that; it has been over 10 years since the introduction of PIP. We need to ensure that our system is fair and accurately targeted at those who need our support most. Although we have made significant progress, the disability benefits system for adults of working age is not consistently providing support in the way it was intended. In terms of a point raised by the noble Baroness, Lady Sherlock, I reassure her and the House that we will and intend to continue to support those who need it. That includes those who genuinely are not able to work—that is what we are doing at the moment. In terms of what may come out of the Green Paper, and indeed this conversation or consultation, that is a most important point that I want to emphasise—which, by the way, the Prime Minister also emphasised.

The noble Baroness, Lady Tyler, asked about the importance of investing in mental health services. She is right; we want to ensure we are providing the right support to those who need it most, targeting our resources most effectively, and supporting disabled people and people with long-term health conditions to live independently and reach their full potential, irrespective of whether this is a physical or mental health condition—which alludes to the point that the noble Baroness, Lady Sherlock, made. Mental health remains a key government priority; that is why we are investing £2.3 billion a year into NHS mental health services, and why we brought in the long-term workforce plan, which will deliver the fastest expansion of mental health services in the NHS’s history. Just this morning, as I said, I visited a jobcentre and found out more about that.

The noble Baroness, Lady Sherlock, asked about PIP and mental health. I will give a few more statistics to back up the views I have given so far. In 2019, there were an average of 2,200 new PIP awards a month in England and Wales, where the main disabling condition was mixed anxiety and depressive disorders. That figure more than doubled to 5,300 a month in 2023. As I said earlier, we will and must continue to support everyone with mental health conditions, recognising that the severity and individual circumstances will vary and that there is no one-size-fits-all approach. Those with the most debilitating conditions should be entitled to the support they need, as I said earlier. That is exactly what PIP is intended to do, and that core aim will not change.

However, we need to have an honest conversation, which we have just started, about whether individuals with some conditions are better served by treatment and tailored support than by cash payments—which I think was a point raised by one of the noble Baronesses. To increase support, we have expanded mental health provision. Altogether, between 2018-19 and 2023-24, spending on mental health services has increased by £4.7 billion in cash terms, increasing access to mental health services. This has put 400,000 extra people through the NHS talking therapies programme, which the House will be aware of.

On the question raised by the noble Baroness about the amount going on, I say that there is a huge amount. We fully intend to go ahead with the reforms that we announced in Transforming Support: The Health and Disability White Paper, because the Government are committed to doing everything that we can to help disabled people and people with long-term health conditions. These changes are separate from this PIP consultation but, as we develop our proposals, we will consider how some interactions with the current welfare system will be reflected in a reformed system. This will be carefully worked through and reported on before we consider introducing any changes. I say again that this is the start of a conversation. We are asking as many people as possible to input into the Green Paper. Already, we have received a good number of responses in the past few days since it was announced.

The noble Baroness, Lady Tyler—it might have been the noble Baroness, Lady Sherlock, as well—spoke about too many piecemeal publications and not enough action. Since 2010, we have delivered significant welfare reforms, including introducing universal credit, a modern benefit that ensures that people are better off in work than on benefit. There are nearly 4 million more people in work than in 2010 and 1.1 million fewer people in absolute low income. However, we are now seeing a new challenge—they come up in government sometimes —that emerged in recent years and accelerated post pandemic. As the Prime Minister said, the current system is unsustainable, unfair for taxpayers and no longer targeted at those who need it most. That is why it is essential that we take action.

On the point raised by the noble Baroness, Lady Tyler, about carers, there probably is not enough time to go into everything I want to say, but perhaps I can give her some reassurance on the issues circling at the moment. We must carefully balance our duty to the taxpayer to recover overpayments with safeguards to manage repayments fairly. Claimants have a responsibility to ensure that they are entitled to benefits and to inform my department, the DWP, of any changes in their circumstances that could impact their award. To be helpful, we have improved, rather urgently, customer communications to remind them of the importance of telling us about any earnings, including in the annual uprating letter that all claimants receive. We are looking to make the best possible use of earnings information collected by HMRC—so-called real-time information—to help to prevent some overpayments occurring in the first place. I reassure the noble Baroness that we are taking this extremely seriously.

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[Viscount Younger of Leckie (Con)]

I take very seriously what my noble friend has said. On the PIP process, she is right. Work needs to be and is being done to modernise the health and disability benefit services to create a more efficient service, reduce processing times and improve trust in our services and the decisions that we make. As part of this, from July 2023, a limited number of claimants have been able to begin their claim for PIP entirely online, which we aim to roll out across England and Wales.

My noble friend’s substantive question was on the important subject of autism. She will be aware of the Buckland review. It is important to say that we will link whatever comes out of this conversation, which may include matters to do with autism, with the progress we are making on the Buckland review. I am aware of the huge challenges linked to assessing those who have autism. On a brighter note, we know most autistic people want a job, and evidence shows that they may bring positive benefits to their employers. Now is the time to raise our ambition. On 2 April 2023, World Autism Acceptance Day, the DWP announced the launch of this new review. My noble friend will know that a task group has been set up that will include people with direct lived experience of autism, and be chaired by a respected independent person who is separate from government and clearly represents autistic people and their needs. The members of the task group will cover a broad range of interest groups to ensure that their views are represented. It is important to link this to what we may do out of the review on PIP. I say “may do” because this is a consultation, and we want to hear from people.

[The Lord Bishop of Lincoln]

My Lords, I declare an interest as a bishop relating to L’Arche UK and worldwide, which cares for people with intellectual and physical disabilities. The aspiration outlined in the Ministerial Statement to create a Britain in which disabled people can be supported to thrive is one that we all share. At a time of economic challenge, any responsible Government must pursue priorities and make difficult choices, but I have been in your Lordships’ House for 10 years and this kind of Statement reminds me of the circularity of this debate about welfare provision within that 10 years, where we do not seem to have made huge progress. We heard a lot from previous speakers about the varied needs of people with disabilities, some people with temporary health issues and those with severe and enduring mental health conditions. The Joseph Rowntree Foundation has noted that almost two-thirds of people living in destitution or direct homelessness have a chronic health condition or disability. These people may be unable to meet their most basic needs to stay warm, fed, dry and clean. Does the Minister agree that energy for further reform of disability benefits might be best applied to meeting the needs of this cohort rather than seeking to make eligibility even tighter?

[Viscount Younger of Leckie (Con)]

I gently correct the right reverend Prelate, or give my view, which is that the current PIP system has served a purpose; that is a fair comment to make. However, as I said earlier, after 10 years—it was our Government who brought in PIP—now is the time to review it. To put this in perspective and explain why we are doing it now, I say that since 2015 the proportion of the caseload receiving the highest rate of PIP has increased from 25% to 36%, and 7% of working-age people in England and Wales now claim PIP or DLA, which is forecast to rise to 10% by 2028-29. Going back to 2022-23, the Government spent £15.7 billion on extra costs for disability benefits for people of working age in England and Wales, and the OBR has forecast that the cost will rise to £29.8 billion in nominal terms by 2028-29. On the right reverend Prelate’s question, we believe that now is the right time to do something. In fact, not doing something would be highly negligent. It covers everybody at all levels. I know he referred particularly to those who are the most vulnerable, and he was quite right.

[Lord Addington (LD)]

My Lords, this Statement should fill us with joy, but anyone familiar with the history of this issue will actually be worried. The assessment has just got a hell of a lot more complicated. In the past, people have been told that they cannot get their benefits, whatever they are called, because they can walk 10 yards—except they could do it one day but not the next, and it was a nightmare. The Government have just made a quantum leap in the complexity of conditions that they are dealing with. That is good, but unless they back it up with better support to make the assessment then they are guaranteeing failure. There is no real argument about that; the noble Baroness, Lady Browning, hinted at it, and others will back me up,

I suggest that something the Minister could do to make the Government’s life easier is to start passporting the identification of problems such as education in earlier life. For instance, there are education, health and care plans, and the disabled students’ allowance. If we cannot passport those into the Department for Work and Pensions, we are going to waste a huge amount of time and effort. Most of these things will have been tested in the courts, or with an assessment. What are we doing there? When we are making new assessments, are we investing in proper identification? That has been a chronic problem in this area. I hope that by now the Government have realised that and put some sort of plan in place.

[Viscount Younger of Leckie (Con)]

I encourage the noble Lord, with his knowledge and experience, to input into the consultation, as I suspect he probably will. He will know that the consultation is limited in scope to PIP, which is open only to claimants aged 16 and over. That is quite broad, but it is payable regardless of whether you are in work, education or, as he spoke about, training. We are keen to hear from people from all walks of life and backgrounds, and encourage everyone, including students, to respond to the consultation.

I take note of the noble Lord’s point about passporting. I know about EHC plans from my previous brief. It is important that the student diaspora and those who represent it also input to the conversation.

As I said, we believe there may be better ways of supporting people in living independent and fulfilling lives. This could mean financial support being better targeted at people, including students, who have specific extra costs, but it could involve improved support of other kinds, such as for physical as well as mental health, leading to better outcomes.

[Baroness Bottomley of Nettlestone (Con)]

My Lords, I commend the Statement and the Green Paper. I regard the Secretary of State as someone with a warm and sincere heart, and a clear head. I think he is an impressive Secretary of State in a complex area. I also commend his Permanent Secretary, who is a quite excellent man.

Obviously, the understanding of disability and ill health changes all the time. This benefit has been around since 2013, and it is time for a strategic review. Earlier this week, we were talking about the late Frank Field. When I worked on benefit agencies with him, it was quite different. With these vast sums of money, we should focus and make sure that the money is spent wisely and well. There is only a certain amount of public money, as another party may discover in a few months’ time, although I can say nothing about that. Money cannot go both on doctors and nurses and on welfare payments, so we have to look strategically.

There are partners. Charities have a big part to play, and the Church is important in dealing with mental health. I remember the effect of Pentecostal choirs on West Indian boys with schizophrenia. They went to the Pentecostal choir, and said that they felt like new men, and I am not surprised.

I want to talk particularly about employers. Good employers have transformed the support that they offer to people with mental illness problems. Prevention is much better than cure, if you can reach out and help someone in the workplace to talk about their mental health problems. I agree about stigma. If you have schizophrenia then you say you have depression, and if you have depression then you say you have the flu. There are a number of employers that have impressed me, which I would point out to the Secretary of State, where there are ally groups supporting people’s mental health, and where facilities and services are provided. Yes, the Government have a part to play, but so does the wider community. Work, for most of us, is a lifesaver. I have never been more miserable than when I was stuck at home during Covid, and I do not think I am alone.

[Viscount Younger of Leckie (Con)]

I thank my noble friend for her kind comments about the Secretary of State and the Permanent Secretary, with whom I am working closely, as she will know.

My noble friend made an important point about the variations among individuals who have conditions. As she alluded to, some claimants will have considerable extra costs related to their disability, while others will have fewer or minimal costs. This is why we have brought forward the Green Paper, looking at whether there are ways in which we can improve how we support people, where that is better suited to their needs and to the way they want to run their lives. I should also say that it is right that it is fairer to the taxpayer than the current system.

My noble friend is right that my department has been undertaking a huge amount of work with employers and that, with the rise in mental health conditions, sometimes people in work feel that they cannot stay in that job because of their condition. A lot of work has been going on to persuade or help them to stay in work, while holding their hands and giving them detailed, experienced, skilled advice on how to cope with their lives. That is working, and I could go into more detail on it, but it just shows that we are alert to the increase in mental ill health that has come about for a variety of reasons, not just because of Covid.

[Baroness Newlove (Con)]

I want to ask the Minister about applying for PIP. Similar to my noble friend Lady Browning’s case, my son-in-law has applied. He has MS and has been advised by his consultant. He has waited six years for a diagnosis and is 32 years of age. His application for PIP was turned down. He works 50 hours a week—he is not lazy at all, or anything like that—and he provides. When he reapplied, it was out of date, and he has just been told that, because he applied online once, he has to use the paper form. That form is 44 pages long. He cannot write or hold a pencil because of his illness—he has his daughter write Christmas and birthday cards. Unfortunately, the person on the other end of the phone does not seem to be sympathetic about that.

It is diabolical that someone with a medical illness like that has been sent a 44-page document to complete in two working weeks when he already feels that he is holding out a begging bowl. But he has been advised to apply by his consultant because working the many hours that he does is having an impact on his health. I ask the Minister to look at that. If we are going to digital, surely the message should not be that you get one chance only to apply online and then any other applications must be on paper.

[Viscount Younger of Leckie (Con)]

I have every sympathy with what I have heard from my noble friend. I will not repeat what I said about the huge changes that we are making to the PIP process, but I am aware of the example that she has given of the 44-page form, which falls into that category.

Perhaps I can go a bit further—this is linked to the waiting times that we know have been apparent for applying for PIP—and say that we have seen a decrease in PIP clearances since August 2021. The latest statistics show that the average end-to-end journey for those applying for PIP had reduced from 26 weeks in August 2021 to 15 weeks at the end of January this year. So we are clearing claims faster than we were prior to the pandemic, which is going in the right direction, and we are committed to ensuring that people can access financial support through PIP in a more timely manner. Managing the customer journey times for PIP claimants is a priority for the department, and we are working constantly to make improvements to the service.

My noble friend mentioned the issue of online. Online is a way forward but it is not necessarily for everyone. We have increased the availability of case managers and assessments, and provided health professional resources, and we have been triaging and prioritising new claims in a better way.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the justification for this Statement and the Government’s plan, repeated by the Minister, is that the level of claims has risen significantly since 2009, specifically mental health claims. Since 2009, we have had a global pandemic and the acuteness of the climate emergency has become obvious to everybody. We have had a cost of living crisis; we have a huge crisis in housing. Surely it is not a surprise that we have very poor levels of mental health across our society. That is a measure of government failure rather than individual responsibility.

Does the Minister acknowledge that there are social determinants of health and that what we have to do is create a healthy society? This Statement makes no reference to that. Also, do the Government accept the social model of disability, acknowledging that the way in which society is arranged and organised is what truly disables people? Why is there nothing in this Statement—not a single reference—to what can be done to push employers to provide appropriate arrangements for disabled people, to allow them to continue to work, rather than focusing on the behaviour of disabled people?

[Viscount Younger of Leckie (Con)]

I know that we— the noble Baroness, Lady Bennett, and I—have had several sessions across the Chamber, and I say gently that, for her to say that all the instances of mental health that have cropped up are purely to do with decisions that the Government have taken wholly misrepresents the situation. She will know, as I think most of the House will, that it is much more complex than that. It is linked to all kinds of issues: for example, the rise in social media and the fact that more young people are on their phones is talked about a lot. So I might chide her that she might have mentioned that, for example.

This allows me also to give one reason why now is the time to look at PIP, given the very sobering figures that I gave out slightly earlier. I now want to go a little further. If we did nothing, over the coming four years PIP spending alone is forecast to rise by 63%, from £21.6 billion to £35.3 billion. That would be for the period 2023-24 right up to 2028-29. But it is not just about the cost. As I said earlier, I hope fairly, it is important that we review PIP to be sure that it is directed in the right way, targeted at those who need it most, delivering the right sort of support for people with disabilities and health conditions and, as I said earlier, providing better value for the taxpayer.

[Lord Young of Cookham (Con)]

My Lords, I agree with what my noble friend has just said and the point made by my noble friend Lady Bottomley that, whoever is in power, the present regime is financially unsustainable. However, I also agree with what the noble Baroness, Lady Sherlock, said at the beginning: the tone and language that one uses when discussing reform is crucial. My noble friend gets that right, but can I ask him about the proposals for the so-called sick note?

At the moment, yes, GPs are under pressure, but they at least know the patient and have access to a wide range of information before they come to their decision. Under the proposals, this will be done by a DWP assessor, who will not know the claimant and will have a limited amount of background information—and relatively limited interaction with the claimant. How confident is my noble friend that that process will be fair and robust?

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[Viscount Younger of Leckie (Con)]

Absolutely. This allows me to talk a bit about the so-called fit notes. I start by saying that we know that work positively impacts people’s physical and mental health and well-being. The current fit-note system, which is the gateway to accessing sick pay and ill-health unemployment benefit assessments, is writing off too many people as “not fit for work”. By the way, it is quite a sobering figure that it is 94% of all fit notes. We need to fundamentally overhaul the system, so that it changes the default assumption by focusing on what people can do with the right support. We know that 10 million not-fit-for-work fit notes are issued every year, so there is a real missed opportunity here.

On my noble friend’s question, we are working on a new process and there is a call for evidence out. This was published on 19 April and we are gathering evidence to assess the impact of the current fit-note process in supporting work and health conversations. It asks stakeholders how they would like to see the fit-note process change to better support people to start, stay at and succeed in work. To that extent, it very much chimes with and links into my department. That is why we are working ever more closely with the Department of Health and Social Care to take forward this important area.