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Column 172opportunity to look in detail at how the medical test will operate in practice, and at those who have been granted or denied the new incapacity benefit.
We need a report that gives a proper analysis, nationwide and region by region, of how the benefit operates in practice. We also need a proper analysis of how the appeals procedure will work in practice. We need evidence and research on how medical reports, GP assessments and the reports of other medical officers and professionals in the medical field are dealt with, to ensure consistency of treatment by claimants throughout the country. We also need to ensure that, throughout the whole process, money is not the guiding principle in determining the Government's response to people's genuine claims for incapacity benefit. People must feel confident that Parliament can come to a considered, reasoned and certain decision because the evidence is before us. The evidence is certainly not before us this afternoon.
Mr. Alan Howarth (Stratford-on-Avon) : I hope that the Government will look carefully at the proposals in new clause 3 and the group of amendments. There is a case for having a report to Parliament on the effectiveness of the medical test and I am sure that my right hon. Friends will be willing to reflect on it and consider it positively. I know that they are looking to develop a system that will work humanely and practically.
The Government have offered us the concept of an objective medical test that contains considerable difficulties. At this stage of legislating, we do not know what the series of objective medical tests will be. We are grateful for the consultative document offered to us, but that itself has been changing, even during the consultation process. It is excellent that no less than 80 experts have been called in from outside the Department to offer their opinions and advice. But I suspect that, even if there were 800 experts, they would still face insurmountable difficulty in developing a satisfactory objective medical test.
Having said that, I welcome the developments which it is reported are taking place, even at this stage, although, as the hon. Member for Manchester, Withington (Mr. Bradley) suggested, the introduction of additional flexibility may take the test a little further away from objectivity.
We are contemplating a test not of incapacity for work but of functional incapacity. The purpose of the exercise is to establish objective and universal measures in a series of scores in tests. Will my right hon. Friend persuade me that that is not an impossibility ? In assessing capacity or incapacity to work, one must consider the interaction in individual cases of a range of factors. One must consider the impairment or illness, which may be a fluctuating condition, in relation to the work experience and skills of the individual in question ; his or her education and training ; his or her personal household circumstances ; and the work opportunities that may be available to that person.
The distinction must not be forgotten between "own work" and "all work"-- the distinction between the work which the person in question has previously undertaken--and whether the person would be fit for that work or similar work and any other work of which that person may or may not be capable. If we ignore that distinction we shall inevitably get ourselves into considerable difficulties.
The Department's research makes us well aware of the difficulties that face people over the age of 50 in trying to
Column 173find jobs, and we are all too aware of the reality of discrimination against disabled people in relation to employment, an issue which we shall have a fuller opportunity to debate on Friday. I remind the House that the Department of Employment's sponsored research in 1990 found that 6 per cent. of employers candidly and brutally said that they would discriminate against disabled people. Another 25 per cent. of employers admitted that they might discriminate. A Spastics Society study found that 34 out of 94 employers, willing to interview, were not willing to interview a registered disabled applicant with qualifications and experience equal to other applicants. It also found that 53 per cent. of employers use pre-employment health screening. That study by the Spastics Society, entitled "Wasted Opportunities", on the activities of training and enterprise councils in relation to training disabled people, also offers a gloomy account.
The disabled are three times more likely to be out of work and they are unemployed for longer than non-disabled people. At the beginning of this month, the citizens advice bureaux produced a gloomy dossier detailing instances of discrimination against disabled people. Against that background, it is difficult--indeed, impossible--to talk in terms of an objective medical test that would define a person's incapacity for work, because incapacity for work in the real world depends on the circumstances in which someone finds himself or herself and those circumstances may be adverse. So incapacity is not an absolute ; it is a relative matter.
Furthermore, we should think positively in terms of ability rather than disability and of capacity rather than incapacity. The title of the Bill, "Social Security (Incapacity for Work)", is somewhat chilling. Although I realise that it is not intended, I fear that the concept expressed by that title may encourage too negative a spirit when it comes to employing disabled people.
There is a good case for having a report on the lines proposed in the new clause. If we are to have a report, it should look at a range of relevant measures within the overall policy. I hope that, by the time the Bill has completed its passage, the report will cover a partial incapacity benefit. It seems appropriate that we should have not just a single absolute incapacity benefit but a partial incapacity benefit which would be proportionate to the degree of disability of the person being supported.
I hope that an amendment of that kind will be instated in the Bill. I know that new clause 5 was not selected for debate today, but there is no reason why it should not be considered in another place, where I am sure those involved in the debate would want to emphasise the value of gradualism and the rehabilitative experience of moving to part-time work, perhaps en route to full-time work. A partial incapacity benefit would be a useful complement to disability working allowance, under which benefit is cut off at a fairly low level of earnings.
Similarly, I hope that a report would cover more generous linking rules, which we do not have an opportunity to debate today, but which I hope will be introduced into the legislation. The trap created by an eight-week rule is a deterrent to employment. I hope that
Column 174we might move to a two-year linking rule under incapacity benefit parallel to the rule under disability working allowance.
The Government's strategy surely must be to get people into work. That is good for them and, of course, for the Government's finances, about which the Government are legitimately concerned. Rigid rules and rigid cut-offs are not conducive to that end and will, unquestionably, be insensitive to the variety of circumstances and needs. The formula used by the Benefits Agency medical service must, at the very least, be made flexible.
I welcome the announcement by my right hon. and hon. Friends that the terminally ill, those on the higher rate care component of disability living allowance, and those on the prescribed list will not be required to undertake the test. I also think that people who are made exempt in that way should be fast tracked on to benefit, but that is a debate for another occasion. We are unable to debate amendments Nos. 17 and 18 because they were not selected. They too may be the subject of a debate in another place.
As has already been argued, the report should cover the involvement of general practitioners. I cannot bring myself to believe that it is right to suggest that doctors consider that it is beyond the range of their normal responsibilities to play a part in the first assessment. I know that they are to offer an opinion on a rather curtailed basis in the first assessment, but because of some of the factors that I mentioned earlier, and because the personal history and circumstances of each individual should be considered, we should find ways to involve general practitioners as much as possible in the process. I know that many general practitioners would welcome such involvement and recognise it as a normal and proper part of their professional responsibilities.
We need to know what role general practitioners will play in appeals. My right hon. and hon. Friends have said that GPs will have a role in the appeal process, but it has not yet been made clear what that role should be. A report should cover that aspect of the procedures.
The report should tell us a good deal about what is happening in appeals. In recent years, the success rate of appeals involving invalidity benefit has risen. I believe that the figure was 21 per cent. in 1979, and 53 per cent. in 1992. A consistent weight of anecdotal evidence on appeals shows that the success rate of appeals has risen yet further since then. I suspect that the search for economies and the administrative guidance prompting benefits officers to be more stringent has perversely led to higher administration costs. In their unsuccessful attempts to weed out a considerable number of "unjustified" claims, they have incurred administrative costs. That has caused difficulties for everyone, both officials and claimants.
The appeal process has lengthened from 21 weeks in 1986 to 30 weeks in 1992. We should also be concerned that it is possible for a claimant not to receive income during those lengthening periods while they wait for the outcome of an appeal. It would be helpful and proper if the report dealt with that matter as well.
The purpose of the legislation is, very properly, to ensure that there is no waste in, or abuse of, this part of the benefit system. It also aims to ensure that appropriate support is provided to claimants who are entitled to it, and that such support is provided reliably and quickly. The objective of the legislation should be humanity, not
Column 175parsimony. It is a part of the benefit system through which we acquit ourselves, in part, of our responsibilities to those who are vulnerable and poor.
There is a good case for having a report laid before Parliament, as the new clause proposes. We are, after all, embarking on an experimental approach that has not yet been fully formulated. For the reasons that I have explained, we cannot yet be confident that it will work. The Benefits Agency medical service will face a massive task. It is estimated that perhaps 600,000 people who currently receive invalidity benefit may have to undergo the test. We will need assurance, therefore, that the procedures and the quality of decision-making are of the necessary standard.
To have a report would be fair to everyone who is sick and disabled, especially those who are rejected at the medical test. They are entitled, as we all are, to see that the system is performing as it should and that proper standards are defined and are being met. Finally, the Government should consider positively the suggestion to provide such a report as it would be a mark of their respect for Parliament and the public.
Mr. Malcolm Wicks (Croydon, North-West) : This is an important Bill and therefore an important debate. The number of people currently receiving invalidity benefit is substantial. The Government estimate that 1.5 million people will receive benefit either now or in about a year, so we are discussing substantial amounts of public resources. More importantly, we are discussing the way in which our society, through the will of Parliament, will treat people with disabilities. For reasons that I think are clear, not least sheer demography, there are likely to be more people with disabilities in our community as we approach the end of this century and a new millennium. The debate is of great importance to social policy.
As hon. Members have said, much depends on the medical test and how we define incapacity for work. I greatly enjoyed the speech of the hon. Member for Stratford-on-Avon (Mr. Howarth). I agreed with him when he said that incapacity was not an absolute concept but was, inevitably, a relative concept. I want to develop that argument to say that incapacity is relative to the employment position. The Government's legislation is based on an assumption which, in the current employment climate, many of us would regard as heroic. It assumes that those who fail the strict medical test will, by definition, be capable of work. I assume that the assumption is that with a bit of willingness those people will not only seek, but find, jobs.
Will Ministers say more today than they have done so far, and more than they said in Committee, about how they view the association between medical capacity for work and the true prospects for gaining work ? I hope that Ministers will respond and consider policy in those broad terms. Parliament today could not agree to the measure with any great confidence if it felt that the result would be that many people with disabilities which were not serious enough to pass the test would be consigned to poverty because they would be unable to find their way into the employment market. I hope that the Minister will say something about that. A strict medical test, regardless of the employment situation, must make for poor social policy.
I will put forward two employment scenarios relating to the medical test. One would be where the medical test was
Column 176being applied in full and buoyant employment, where not only were the official unemployment levels very low, but there was a shortage in the labour market and employers were crying out for decent labour. In those circumstances, employers would be bending over backwards to accommodate people with disabilities. They would be heavily into training, they would be adapting their premises and they would in a variety of ways be sensitive to the needs of those with disabilities.
We all know that to assume that people with disabilities--even serious disabilities--are not capable of work represents great prejudice and potential discrimination against such people. There are remarkable people around--we have all had them as colleagues in different walks of life--who, despite many disabilities, are making a major contribution to their workplace and therefore to the economy. Professor Stephen Hawking labours under the most considerable disabilities imaginable, yet he is one of the most brilliant scientists in the west and has made a major contribution not only to his university, but to the enlightenment of us all. To assume that someone with even such grave disabilities was incapable of work would be a great slur on that man and many others less famous. In the right employment conditions, many people with the most grave disabilities are capable of work and, equally important, should be able to obtain work. In the right circumstances, we might have more confidence about even a strict medical test.
Sadly, the employment scenario that I have outlined is very far from the reality in the United Kingdom. Instead, for many the reality is not employment, but unemployment ; there are 3 million or 4 million people out of work, the trends in the labour market are towards less security and permanence and people have to chop and change their jobs.
Increasingly, Ministers and other pundits make a virtue out of that. They say that those are the circumstances that workers will have to face in future ; they will have to retrain constantly and no job is for life--even for those with safe seats in the House--and that people should not expect such security. In those changed employment circumstances, it will become more difficult for people with disabilities to find employment. I wonder how the Government would present their Bill to us in that context, which they will need to address.
The evidence so far, without taking account of developments in the most recent years, is worrying for the employment prospects of those with disabilities. In 1989, Social and Community Planning Research estimated that 22 per cent. of people with disabilities who regarded themselves available for work--the so-called economically active as the statisticians would have it--were out of work. If the Government have data for a more recent period, they would be useful, because I suspect that things have changed for the worse, even since 1989. Another report in 1992, from Stephen Smith of the Spastics Society, found that employers were six times more likely to turn down people with disabilities for interviews even where their qualifications, experience and CVs were just as good as those who were not disabled. We face a problem of discrimination from employers ; it is well known to the House and well documented. Other Government studies have estimated that it is 2.5 times more likely for people with disabilities to be out of work than those who are able-bodied.
Column 177A survey organised by the voluntary organisation, PACT in Brighton, also relates to the debate. It found that 40 per cent. of employers in Brighton regarded people with disabilities as unsuitable for employment. That is another example of the prejudice and discrimination that we face in Britain.
Perhaps the most telling to the House is that many years ago, shortly after the second world war, the House in its wisdom passed a Bill saying that larger employers--those with 20 or more workers--should have a disability quota of 3 per cent. of their labour force. We understand that, despite having had many years to implement that measure, three quarters of employers do not meet the quota. Since 1975 there has been no prosecution to enforce it. That suggests that, although we may willingly pass legislation in the House, we are rather lax in its implementation.
Still on the theme of the association between the medical test and the reality of finding work, I was struck by a briefing that many of us received from the Policy Studies Institute written by one of their senior social scientists, Richard Berthoud, about the reality behind the medical test. He talked in particular about discrimination by employers. I quoted from it in Committee and I shall quote a paragraph today, as it makes an important point. It states : "At a meeting of the panel of experts' convened by the DSS to discuss the medical assessment, a disease was described which caused people to tremble permanently and uncontrollably. People with this disease are not impaired in any way : they could stand, walk, sit, grip, reach and do all the other things required by the medical test. But other people, it was said, could not bear to watch them--they became upset and could not concentrate on their own tasks. As a result of the effect on other employees, no employer was prepared to hire someone with this condition."
The reaction of the panel would be the reaction of many of us in the House- -we would be appalled. Many suggested that it was outrageous and that employers should be made to hire those people. But in reality, sadly, many employers will not hire such people because of their effect on other employees.
The document went on to say that most people would agree that employers and employees should not discriminate in that way and that perhaps they should be banned from doing so. However, as long as discrimination persists, removal of trembling and other socially embarrassing conditions such as disfigurement from the assessment criteria would mean that those affected would be denied incapacity benefits and face the punitive treatment offered to the unemployed. Here we have the real and complex association between the danger of failing a medical test, because, objectively, the person can work, and the reality whereby the prejudices of many ordinary people and employees and the prejudices and discriminations of employers mean the person cannot find work.
Again I put it to Ministers : what are the employment prospects of those who may fail the medical test ? Do the Government think, even at this stage, that it is wise to bring to the Chamber legislation which, however scientifically well constructed--and we do not know that, because we do not have the details--nevertheless does not seem to take account of current reality ?
I have received correspondence from people who say that in practice, in the labour market today, if they have a disability, particularly if they are no longer very young,
Column 178they find it difficult to get work. Someone wrote to me from Kent saying that his local disability employment adviser had written to him and said that he was unlikely to get a job. Why ? He was told : "Because of the changes in companies employment policy as a result of the recession, your age, your disabilities, which would preclude you holding down a full or part-time job, and the fact that you have not worked since 1987."
The DEE went on to say :
"I am sorry, but you are now unemployable."
I do not know the full details of that case, but that may well be someone who passes the test prescribed by the DSS but fails the most important test of all--the jobs test--and ends up not in employment but in unemployment.
I would like to add to what has been said by hon. Members in Committee and in the House today about those who have conditions that fluctuate from day to day, week to week or month to month and put this important point to Ministers. How will the medical test allow for those who perhaps on the day of the test seem to be relatively able-bodied and therefore capable of work according to the legislation but who perhaps the next day, week or month have a relapse and find that they cannot work ? That is of real concern. I am told by those with ME--myalgic encephalomyelitis--including those who come to see me in any constituency office in Croydon, that on some days, despite suffering for many months, they may feel relatively fit and confident about life and the prospects of work, while on another day they may wake up in the morning and find it almost impossible even to get out of bed, such are the debilitating effects of ME and similar conditions.
The point was mentioned in Committee, but I will put it again to Ministers. How can a test, however sophisticated, allow for such a condition on the day ? It appears to be true for those with physical conditions. I suspect, although I am no expert, that it is even more true for those with mental illness, certainly certain forms of mental illness. Again, someone from Croydon came to see me, speaking on behalf of those in the Manic Depressive Fellowship--those who suffer from the terrible condition of manic depression. He told me a similar story--that on one day he may truly be one of the most depressed people in the community and be almost unable to function, certainly not in the labour market and hold down a job.
He used to be a lecturer at a college. After many years--indeed, decades-- of battling against his manic depression, he finally had to succumb and leave his place of work and is now dependent on invalidity benefit. He said that on some days he is really down, but because his condition fluctuates from week to week and month to month, at other times he may be almost up in the clouds and almost too active--indeed, hyperactive. It makes him do foolish things. He gives away too much money to his charitable causes. That is a fluctuating condition. How would a strict medical test allow for that ? This is a serious debate. I am not making a polemical point. I am interested in how the Government can devise a test to allow for the reality of people's conditions, because we all know that the prospects of any of us at some stage becoming mentally ill are quite high. We are not talking about small numbers of people, but about a large percentage of men and women. How they will be treated is important.
It would be helpful if the Government could tell us more today about the conditions that will be on the exempt list.
Column 179I welcome the assurance given in Committee that, although they are not shown on the face of the Bill--I understand that--people suffering from many other conditions, including those suffering from AIDS and symptomatic HIV, are likely to receive extremely sympathetic treatment from Government when the exempt list is drawn up. If Ministers have a moment today to confirm that assurance, I know that many people would be most grateful.
In my experience, social security, while often presented in terms of policy, grand principle and key objectives, depends crucially on its detail. It is therefore up to the House to take its role as scrutineers of legislation extremely seriously. Again, I offer this not as a polemical point but as a serious contribution to the debate. Having served on the Committee that considered the Incapacity for Work Bill, I have been appalled by the manner in which Conservative Back Benchers treated the Committee in such a cavalier way. I have been on Committees for smaller Bills, but that was my first major experience. I offer, therefore, an innocent essay on what I found. But I was genuinely surprised and appalled by the way in which Conservative Back Benchers approached the Committee.
It is partly a function of the fact that, sadly, the more independent- minded Conservative Back Benchers were on the exempt list and not allowed to serve on the Committee. It was packed, I suppose, with trusties. At one stage--it was a rare moment--a Back Bencher rose to make a contribution and said that he would be very brief. Indeed, he had promised his Whip that he would speak for only four minutes. Those of us who--at our teacher's feet-- studied the British constitution, read textbooks which, I now realise, came from the section called "Fiction". They told us the story that, having been considered in broad terms in the Chamber of the House of Commons, a Bill is then subjected to scrutiny line by line in Committee. That includes this most important matter that we are discussing now about the medical test.
The Bill was subjected to scrutiny in great detail by Opposition Members, but not by Conservatives. I was genuinely surprised that certain Conservative Back Benchers spent more time in conversation with their secretaries on constituency matters in the Committee Corridor than they did in Committee. When challenged on that, because we tried to encourage genuine debate and scrutiny, one Conservative Back Bencher--I forget which one--said, "Don't tell me this. I approve of the Bill. I do not need to be here."
Surely that is not the point. Either we take the scrutiny of such proposed legislation seriously--not least social security legislation, where the detail is so vital ; hence the debate today about the medical test and our urging of a report--or we do not. I think that the Bill, in a sense, has become a case study of poor Government and poor parliamentary scrutiny.
Mr. Adam Ingram (East Kilbride) : I am sure that the Conservative Back Bencher to whom my hon. Friend referred was the hon. Member for Teignbridge (Mr. Nicholls). My hon. Friend will notice that he has not even attended this evening's debate. I am sure that it has not escaped my hon. Friend's notice that few Conservative Members have turned up for the debate on this important aspect of the new clause. Perhaps that is something that he would want to write into his revision.
Mr. Ingram : My hon. Friend informs me from a sedentary position that the hon. Member for Teignbridge was not on the Committee, but I am sure that when my hon. Friend amends the textbook on the British constitution, this will prove a major part of the new edition.
We are dealing with a serious matter. Although I do not want to strain your patience, Mr. Deputy Speaker, many of us returned time and again in Committee to one of the recent pieces of social security legislation--the Child Support Act 1991. Why ? We now find that that piece of legislation, which went through Parliament and Committee, is causing an almighty row because what we may regard as "the detail" is blood and thunder detail for families in this country. I understand that today there has been a huge lobby of Parliament because people are upset by the detail.
At this stage, the medical test and the Bill are not causing a furore ; the Press Gallery is not packed. Whatever parliamentary correspondents do, we find that they do not correspond with Parliament. No journalist ever attended the Committee stage of the Bill. It will be different, however, when the effects of the detail come home to roost. Constituents will turn up in our surgeries, saying, "Once upon a time I would have received such and such a benefit. I have just taken the medical test, but I did not pass : I was told that I was capable of work." My constituents will then say to me, "Mr. Wicks, I tried my best to find work : here are my applications. I have been told that, because I have a disability and am over 50"--or 55--"I shall not be able to find work."
I know what will happen. Conservative Members will say, "How can this have happened ? We do not understand it. Who was looking after the detail ?" Indeed, I have heard Conservative Members say of the Child Support Act, "I support the principle"--that ritual cry--"but I did not know that it would be like this." I suggest that even those hon. Members who spent hours in the Corridor when they should have been in the Committee Room will say to Ministers, "What has happened to the detail ? A man cannot find work ; he has a disability ; yet he has failed the medical test. Think again."
This is important. We should draw lessons from our recent experience of scrutiny, or rather lack of scrutiny : Bills, not least social security Bills, should include social impact statements spelling out the implications for people in the real world, and there should be pre- legislation hearings. I remember the Minister of State's saying that he thought that that was a good idea. We need Back Benchers on both sides who, while playing a party role, also take very seriously
Column 181have given you an opportunity to intervene earlier ; I have done my best with my north London accent. I am glad that you have allowed me to express some of my thoughts, because the way in which we scrutinise the legislation is clearly important.
We should consider very carefully the motivation behind the Bill and the medical test. Have we been presented with a measure that is principally a piece of social policy--including the provision for the medical test, which we think warrants an annual report--or with a piece of financial policy ?
In Committee, we were assured that the medical test provision was truly a piece of medicine--a piece of science--which had little to do with finance or the Treasury. I know you will consider what I am about to say very relevant, Mr. Deputy Speaker. The Bill contains no impact statement about people, but it contains such a statement about money : we are told that, by 1996-97, gross savings of £1.45 billion will have been achieved.
How can we be confident that the medical test will be objective if we already know the bottom line ? The Treasury has set the targets. Whatever the details of the medical test, and whatever the committee of experts may come up with, the threshold for receipt or non-receipt of benefit will have to be set according to financial targets. I have thought hard about this, and I consider it wise of my hon. Friend the Member for Manchester, Withington (Mr. Bradley) to suggest an annual report on the test if the Bill is enacted--which I hope it will not be ; I hope that the House will think again. We should be able to see for ourselves how the test is working in practice--whether it is working according to a financial criterion, or just according to a medical one.
If we allow the Bill and the medical test to proceed, the inevitable consequence will be the impoverishment of many people with disabilities, and their further marginalisation in the community. That is the great worry. In future, more people who do not receive this benefit will find themselves on unemployment benefit or income support : that is clear from the financial statement in the Bill. The Government admit that although there will be gross savings, there will also be marginal costs as a result of the increase in income support and unemployment benefits. Perhaps Ministers will now come clean, and tell us how many more people with disabilities--people whom we should be looking after--will become dependent on means-tested income support if the Bill is passed.
I think that there is an alternative to the medical test. It should be understood that people with disabilities are full citizens who should be part of an active society. The best policy that we could introduce is not about incapacity, but about capacity and full employment. Unless we return to full employment, we shall never be able to integrate those affected by the Bill into the community. If the Government are assuming mass unemployment in the future, it seems that more and more people with disabilities will become marginalised and unable to seek work ; more and more will depend on income support. I believe that there is an alternative way forward, in terms of a public policy with decent social implications for people with disabilities which would also make economic sense.
In Committee, Conservative Members--occasionally, when they were present-- would throw the following
Column 182thought at us : "Are you saying that you would spend more money ?" I think that we are saying that the right package of economic and social policies for those with disabilities
Mr. Wicks : I am coming to my final paragraph, Mr. Deputy Speaker. I firmly resist the charge that financial costs are attached to our suggestions in Committee. I believe that there is a way in which the House- -and even the present Government--can think about people with disabilities and the range of policies that they need which would not only be desirable in social terms but would make economic sense to our community.
Mr. James Wallace (Orkney and Shetland) : My hon. Friend the Member for Roxburgh and Berwickshire (Mr. Kirkwood) usually speaks for the Liberal Democrats on social security matters. Unfortunately, he has been placed in an unenviable position : amendments have been tabled in his name both here and in the Standing Committee of which he is currently a member. As he has no party colleague in the Committee, it fell to me to deputise here--which I do with some trepidation, given the thoughtful speeches that we have heard so far. It is clear that hon. Members on both sides of the House have given the matter considerable attention and thought.
It is apparent to me that the application, or the detail, of the all-work test is so vague, unpredictable and unknown that--having briefly looked through some papers--I may know as much about it as almost any other hon. Member who is present. As I listened to the debate and tried to take in what was happening, I had some horrible ideas about what might be in prospect.
The hon. Member for Croydon, North-West (Mr. Wicks) referred to someone in the position of Professor Stephen Hawking. Let us suppose that someone who had not even acquired O-levels found himself in exactly the same medical condition. It sounds to me as though such a person would be deemed fit for work, and able to take on the job of professor of science at one of our leading universities.
The Minister may say that that could not possibly happen
Mr. Wallace : But I am not entirely persuaded by what I have heard so far. I accept that I have given an extreme example, but I feel that in any event there is considerable scope for injustice and unfairness to be visited on people with disabilities, or what could be described in common parlance--as opposed to the legal terminology that we are about the pass into law--as incapacity for work. One can perhaps think of a number of such factors, and the hon. Member for Croydon, North-West referred to a report by Richard Berthoud of the Policy Studies Institute which outlined some of the circumstances that could arise.
The report draws attention to the case of a person who is academically well qualified and lives in a town where there is a considerable amount of service industry, especially clerical jobs. That person sustains a serious
Column 183injury to his leg but, after it has healed, is able to return to employment and take up the clerical duties in which he was involved before.
Another person in the same town who suffers exactly the same accident might have a different employment history. Perhaps he left school without any qualifications and laboured on a building site. He might have the same physical injuries, but suitable employment opportunities might not be available for him.
We are being asked to accept a test that relates purely to the narrow range of medical functions. It is merely a check list that will be ticked off, or otherwise, but which will take no account of how a particular medical condition can affect someone. It is not simply a matter of whether someone is capable of walking 100 m ; there might be psychological effects. A person's previous training and the current job opportunities must be taken into account. What are a person's living circumstances ?
In my constituency, many people live miles from the nearest town. An injury that renders them incapable of driving a car might cut off a range of employment opportunities, but, if they lived in the middle of a town, a good number of employment opportunities might be open to them.
Another mental picture of the system being set up is that it resembles the competitions or quizzes that sometimes appear in magazines. One is asked questions A, B and C, and one receives five points for A, two points for B and zero for C, and the points are added up at the end. It seems that we are devising a rigid system under which points will be added together : if one scores more than a certain number, one is disqualified from benefit, whereas if one falls beneath that number, one qualifies.
I accept the point made by the hon. Member for Manchester, Withington (Mr. Bradley). He said that the application of such a system places a great deal of power in the hands of those setting the rules. One of the briefings that I have seen believes that the Government estimate that 400,000 current recipients of invalidity benefit will have to undergo a new test as their cases come up for review, and that as many as 250,000 will no longer qualify. I have no doubt that an estimate has been made--it was probably in the original Bill before Second Reading, when the financial consequences had to be spelt out--of how much saving will accrue to the Treasury. One has the feeling that, as long as there is a strict objective test with a score card, it will be possible to make adjustments to ensure that the anticipated savings materialise, and that is quite apart from the effect that the system could have on individuals.
The hon. Member for Croydon, North-West made another important point. It is not only a question of incapacity for work or otherwise, but of a person's ability to get work even if he or she is deemed to be capable of work. This raises the question of the prejudice and discrimination that is often suffered by people with disabilities. I remember that, in the days when I was my party's employment spokesman, the issue of the 3 per cent. quota arose. It was clear that it was honoured far more in the breach than in its enforcement. I fear that we are ensuring that many people will lose on invalidity benefit, without any obvious road back to employment.
It might not be possible to get them but, in addition to all the figures that the Government would be asked to put before Parliament under new clause 3, it might have been
Column 184useful to add another one--what percentage of those who have been deemed capable of work got jobs within two months of that determination being made ?
Some element of judgment must come into play, and it is important that general practitioners should have a role. Many doctors are not keen on having thrust on them the duty of being, as it were, enforcement officers on behalf of the Benefits Agency. It is perfectly understandable that they do not want to be the last arbiters, but I am sure that all hon. Members will agree that GPs nevertheless have an important role to play.
In Committee, the Under-Secretary of State, the hon. Member for Bury, North (Mr. Burt), said :
"GPs retain an important role."
He said that a GP's input would be
"a vital part of the consideration . . . We are not writing GPs out of the picture."
My colleagues and I tabled amendment No.22 because we seek some way to ensure that the role, advice and information of GPs can be properly channelled into those considerations.
The Minister also said :
"The GP's opinion on whether a person is incapable for work is not specifically sought."-- [Official Report, Standing Committee E , February 1994 ; c. 351-2.]
He said that after having said that consideration of the GP's opinion was part and parcel of the process. The purpose of amendment No.22 is to ensure that, in regulations, a way is defined "in which relevant evidence or information submitted by that person or by any medical practitioner or professional health worker will be used during the assessment".
It is our concern that such a method is introduced as early as possible.
The briefings which I think all hon. Members will have received from citizens advice bureaux give examples of cases in which the absence of a general practitioner's involvement at the critical tribunal stage led to benefit being withdrawn and having to be granted again after an appeal, or even in the intervening period. For example, a CAB in the west midlands reports that a woman in her mid-fifties was examined by a medical officer after four months on invalidity benefit. She was found fit for work, but, at the tribunal, on presentation of a letter from her GP, the Benefits Agency presenting officer conceded that the withdrawal of invalidity benefit had been inappropriate. Similar cases of invalidity benefit being withdrawn but restored after a report from a GP have been reported in Staffordshire and the north-east.
We want GPs to be involved in the provision of essential information. Not only should that be recognised and accepted as part of the process, but the way in which the information is to be channelled into the process should be formally set out. It should not be left to chance or good fortune, or to whether someone has got around to getting their GP's view.
It is not necessarily true that GPs are usually lenient. Indeed, one survey showed that 80 per cent. of respondents believed that their GPs sometimes refused sick notes to people whom advisers considered to be unfit for work. We should trust the medical profession to give its view--a view very often based on long experience of the person involved.
On the day that a person is assessed, he may be capable of carrying out particular tasks and functions, but a medical person who has had the opportunity to see the progress of