|Previous Section||Home Page|
How will the test work ? What will take place ? I am sure that the Minister will be happy to tell me.
The new clause also requires
"an account of the reasons for determinations of capacity for work".
In the absence of any details from the Government, we can conclude only that the decisions will be subjective and will be made on the spot and that the same injustices, unfairness and different treatments that exist with the social fund will result from this legislation. Benefit will depend on whether one turns up on a Monday, or in March, or on whether one comes from one side of the street or the other. We already have an example of imperfect legislation causing great unhappiness.
In new clause 3(e) we are asking for
"an assessment of the medical test by such persons whom the Secretary of State may choose".
The test is new and we are going into uncharted waters without a rudder. Therefore, it is crucial that the Government accept the new clause.
Mr. Burt : I am grateful for the opportunity to respond to a variety of remarks on the amendments. I shall be as brief as I can, but I will try to cover them all. The hon. Member for Manchester, Withington (Mr. Bradley) made many of the remarks straightforwardly, and they were amplified by some of his hon. Friends.
New clauses 3 and 4 would require my right hon. Friend the Secretary of State to report to Parliament on aspects of the operation of the new incapacity benefit. New clause 3 wants such a report no later than 30 September 1996 on the operation of the new "test of incapacity for work".
The new clause also requests details of people who attend medical examinations under the Act between April 1995, when the test will be introduced, and September 1996.
There is a case to be made for the provision of information about the workings of the legislation, but I am not certain that there is a case to be made for the publication of a report as such. We shall collect
Column 196information of this type, and we believe that we shall do so in better quality and greater quantity than the new clause suggests. It would not be wise to restrict ourselves to the time scales and other parameters of the new clause.
In the case of any social security benefit--new or existing--we routinely collect a wide range of statistical information. This is published both in the annual reports of social security statistics and in specialist studies, which include evaluation reports on specific benefits. It is all the more important that new benefits be monitored in order that their effectiveness and performance may be evaluated.
The new incapacity benefit is a good example of one that will be subject to very careful monitoring. The introduction of incapacity benefit brings a considerable change to the current provision of benefits for the sick and incapable by refocusing the benefit on those who, for medical reasons, are incapable of work.
By September 1996, incapacity benefit will have been in place for 18 months, and we shall have collected much information about its operation. I see no advantage in making reports to Parliament along the lines suggested, but the information will be available to hon. Members from a variety of sources, including the statistics that I have mentioned already, and parliamentary questions.
Mrs. Dunwoody : The hon. Gentleman will know that, increasingly, hon. Members who put questions to his Department are referred to the relevant agency. They are told that the agency must take responsibility for day-to-day operations. The hon. Gentleman has not made a case for not publishing statistics, and he certainly has not made a case for Ministers' refusal to answer questions on the Floor of the House. Why cannot we have a report that is capable of being discussed by Members of Parliament ? By his own evidence, he will by then have information.
Mr. Burt : The hon. Lady will be aware that answers to parliamentary questions that come through executive agencies are published, and that Ministers are responsible for answering on the Floor of the House any oral questions that relate to their work. In addition, there are plenty of opportunities for debate in the House about such matters.
Mr. Burt : It will depend on the nature of the question. Hon. Members know that the next steps agencies are being developed in an attempt to separate the operational arm of Government from the policy arm. Policy questions are always answered by Ministers, but questions about operations can be answered more speedily by the executive agencies. Ultimately, however, Ministers are responsible for operations.
Mr. Dafydd Wigley (Caernarfon) : I should like to refer to a matter that I raised during a recent meeting with the Minister. Can the hon. Gentleman assure us that, under the new regime, the range of questions answered will be no narrower than in the past ? Can he give an assurance that, when an hon. Member presses for an answer from a Minister rather than from the agency, the Minister will not refuse to reply ?
Mr. Burt : The rules governing parliamentary questions may be a little more strict than those governing letters. Suppose, for example, that an hon. Member presses for an answer from me about a particular operational matter relating to the Child Support Agency. I take the view that the chief executive should first deal with the query. That is the purpose of the agency. However, if ultimately pressed, I shall answer by letter. Slightly different rules may apply to parliamentary questions. However, such questions are always published, so the information is made available.
I should like now to deal with a number of specific issues in relation to new clause 3. The debate was started with the usual comments about the Government's mean-mindedness. I should like to put in hon. Members' pipes three facts for them to smoke later--if such a metaphor is not politically incorrect these days.
The Government's record on benefits for disabled people is extraordinarily good. Spending has increased by 225 per cent. since 1978-79, and it is currently some £16.5 billion. The disability living allowance, which the Conservative Government introduced, has already brought 500,000 successful claims. Expenditure on invalid care allowance was £4 million in 1978, and it is now £366 million. I could give many more statistics, but I shall not do so. Any suggestion that the Government have been mean-minded in relation to the disabled is absolute fantasy, so I do not expect to hear that argument again tonight.
The test of medical incapacity for work has constituted the meat of this discussion. What do we mean by "medical incapacity for work" ? [Interruption.] I tried in Committee to give an explanation, and I am happy to repeat that explanation for the benefit of those who were not members of the Committee and for those who want further clarification.
We mean a restriction or lack of ability to perform the activities involved in working. We do not mean a restriction or lack of ability per se. Nor do we have in mind the fact that the likelihood of getting a particular job is reduced by factors other than medical ones. We are interested in the point at which the ability to do any form of work is substantially reduced--not the point at which all work becomes impossible.
We are trying to establish a threshold above which it would be unreasonable to expect people to work. Many disabled people will choose to work, but benefit will be available to those who do not. This is the Professor Stephen Hawking argument. There will clearly be no question of anyone in a position like that of Professor Hawking being required to work. That that remarkable man is able to work bears testimony to the fact that there are others, similarly disabled, who work
The threshold is not one above which it would be reasonable to expect anybody to be able to work. [Interruption.] Exactly : if Stephen Hawking can work, anyone can work. Clearly, that cannot be the test.
We are trying, through a process of consultation and consensus, to get a wide range of people--panel members and those they consult--to provide their definition of
Column 198incapacity for work : a definition that relates functional limitation to a substantial reduction in the ability to do work of some kind. That is what is being discussed at the moment. A number of points were made by my hon. Friend the Member for Stratford-on- Avon (Mr. Howarth), whose contribution I greatly appreciated. My hon. Friend referred in particular to disabled people's disadvantage in the jobs market.
All employment services and training--enterprise and education programmes and services for unemployed people--are open to people with disabilities, often with the entry criteria relaxed. There is a wide range of services and schemes for those who need special help. In 1992-93, 62,978 people with disabilities were placed in jobs. That is an indication of what can happen, and it is a point of great importance.
A number of questions about the snapshot element were raised. Is the medical test a snapshot ? No, it is not. It involves the completion of a questionnaire by the claimant, a statement of diagnosis by the claimant's general practitioner, a list of principal disabling conditions and, where required, referral to a departmental doctor for a report or examination.
The departmental doctor who examines a claimant will take account of the variability of the condition over given periods. Thus, the assessment will create an overall picture of the effect of the medical condition on the person's ability to carry out a range of work-related activities, and hence his capacity for work. This is an appropriate point at which to mention the role of the general practitioner. As I said in Committee, the GP plays his vital role at the beginning of the period of incapacity, when it is still the GP's medical certificate that counts. Of course, it is very important that the GP should feel that he has a continuing role to play and may submit information on behalf of the patient at any stage.
Several hon. Members made a point about whether the GP's role was appropriate. It was alleged that we had suggested that, in some way, general practitioners had not been doing their job. That is not the point. General practitioners themselves have been concerned about their role.
I want to quote from a report to indicate that I am not the only person who is saying this. The medical journal Monitor Weekly of 2 June 1993 said :
"More than two-thirds of the 100 GPs questioned by Monitor admitted they had signed a sickness benefit form for patients whom they knew not to be sick, or for an illness that would not prevent the patient from working."
That is borne out by other studies, which have shown that it is a question not of GPs' deliberately avoiding the test but of their taking part in a way that they find inappropriate as the gamekeepers in the area of this benefit.
Mr. Burt : No one claims that the point made by GPs and what they have said over a period is invalid. Again, I am making the point that GPs retain a role in this benefit right the way through, but do not have the definitive and distinctive role that they had in the past. I see nothing wrong in that.
Turning to other issues, some hon. Members asked about particular illnesses and whether, on their own, they
Column 199would be a matter for a decision. The effect of any medical condition or disorder on the capacity to work is of cardinal importance, but such an effect can vary in intensity, over time, from mild to severe. We are taking steps to ensure that the needs of people with such conditions are addressed in developing the new tests. As part of the development of the medical assessment, in-house studies have researched the extent to which certain complicating factors, such as pain, stiffness and fatigue, may affect capacity to work. [Interruption.]
This research has been incorporated in the development of the medical test so far. The consultation exercise has informed the debate, and a consensus will be reached, to give sufficient and appropriate weighting to such factors in the medical test. I turn now to information about the panel and the allegations there. Once again, the hon. Member for Leeds, East (Mr. Mudie), in particular, and the hon. Member for Newport, West (Mr. Flynn), suggested that these people were being kept well away from the public, working in secret, working in caves.
All I can say is that members of the panel will certainly have had full access to the reports of the Committee and of these proceedings in the House, and I imagine that they would want to keep well away from hon. Gentlemen like the hon. Members for Leeds, East and for Newport, West if they believe all they read about them.
In relation to anonymity, we decided at the outset that the participants in the expert panel exercise should be anonymous, to ensure that they could give their professional input without the possibility of any external influence. [Interruption.] We have, however, readily agreed to give details of their areas of expertise. [Interruption.]
Mrs. Dunwoody : I am deeply grateful to the hon. Gentleman. Is he aware how many doctors, male and female, sit on how many assessment panels, how many research papers they publish, and how much effort they put into researching a vast number of medical conditions and their implications ? Why does the Minister have this poor, weak, pathetic, little group who must be protected, not only, according to him, from hon. Members but also from the general public, because they are somehow terrified that their views would be influenced ? How many are there ? How often are they protected ? Is this the only way in which the Minister protects them, or does he protect them in other spheres as well ?
Column 200The group has access to anybody it wishes, and should its members wish to beat a path to the hon. Lady's door, they will no doubt do so. We have readily agreed to give details of their areas of expertise, and the answers to a number of parliamentary questions confirm that that is the case.
Once the expert panel have completed their work, we will give full details of all those who were approached. The idea is that we should issue a report round about August, which will summarise the results of the consultation exercise, the work of the panel and the evaluation exercise and which will also give details of who they are. There will then be an opportunity to consult in relation to the work they do, with a view to trying to get down to a test.
So there is no way in which this work can be said to be done in secret or anything like that. It is very important that the results of the panel's work are published in a formal report, so that they can form part of the debate on the regulations which will establish in law the medical test of incapacity for work.
Mr. Howarth : Before my hon. Friend moves away from the matter of confidentiality, may I press him on confidentiality in another but relevant context ? He will be aware that one reason for the increasing number of appeals is that applicants are not made aware of the contents of the reports produced by the Benefits Agency medical service. Will my hon. Friend ensure that in future those reports are made available to claimants ? It will show a properly respectful attitude to claimants, and it may mean rather less time, energy and resources wasted in appeals.
New clause 4 seeks details of those appeals heard more than 10 days after they were made, a summary of the outcome of all appeals, a report on the extent to which medical evidence influenced the appeal outcome, a summary of the reasons for any failure by claimants to attend the hearing, and a report on the use made of claimants' representatives at an appeal.
The Benefits Agency and the independent tribunal service are committed to looking at ways to improve the clearance times for appeals across the whole social security benefit system. There has been considerable activity to identify and eradicate causes of delay, and there are some indications that this is already successful. Every party, including claimants, representatives and adjudication officers, is entitled under Social Security (Adjudication) Regulation 4(2) to at least 10 days' notice of a hearing. Times run from the date of posting of the appeal papers to the day before the hearing of the case. However, both the claimant and the adjudication officer will wish to prepare submissions before a hearing is confirmed. Furthermore, the claimant's representative will require time to prepare, and often he or she is unavailable for the designated hearing date, necessitating a postponement. I hope that hon. Members will acknowledge the sheer impracticability of the suggestion that appeals should be heard within 10 days of their being made. I am not certain what purpose the final two parts of the new clause would serve. Where the claimant is absent, the tribunal will satisfy itself that papers were duly notified and whether the claimant has indicated an intention to be
Column 201present, before considering whether to continue with the hearing. The Department has no obvious interest in the reasons for a claimant's absence or a yearly summary of those reasons. Similarly, it has no interest in the use made by claimants of representations at an appeal.
We are rather confused by amendment No. 22. It appears to seek to ensure that the Secretary of State shall set out in regulations the manner in which evidence and information are to be used in the assessment of incapacity.
If the House is looking for reassurance that all evidence, whether provided by the claimant, his GP or another person, will be properly considered in the assessment of incapacity, I can provide that reassurance. All relevant evidence will be taken into account at all stages, both in the Benefits Agency medical services doctor's assessment of the claimant and in the adjudication officer's determination of incapacity. Nothing will be excluded.
I question the need for amendment No. 24, the purpose of which is to require the claimant's GP to sit with the tribunal where the appeal concerns determination of the capacity to work. I am sure that the medical profession would not wish to spend time and resources in that manner. GPs, and the British Medical Association, have said for some time that acting as policemen for the social security system can undermine the doctor-patient relationship. They have complained for many years of an ever-increasing amount of paperwork.
The new method of assessing medical incapacity will mean that GPs need to complete many fewer statements of incapacity, and that the Department will be writing to them for further reports rather less often. I fail to see, therefore, what purpose amendment No. 24 serves.
In relation to amendment No. 25, our intention is that appeals against decisions made by an adjudication officer on incapacity benefit shall go to social security appeal tribunals. The tribunals comprise a legally qualified chairman, who guides the proceedings and advises on the law, and two lay members. The arrangement reflects the existing provision in invalidity and sickness benefits.
The most sensitive appeals on incapacity benefit will be those which concern a dispute about the level of the claimant's functional limitations. In these cases, we think that the tribunal should have access to independent medical expertise. The members of the tribunal, who are trained and expert in this, will weigh the evidence and they will make the decision.
I believe that the new clauses and amendments will not provide any additional benefits for claimants, and I invite hon. Members to reject them.
Mr. Bradley : The Minister's explanation has done no more than reinforce our view that an annual report is required. He started by claiming how good the Government's record was on benefits for disabled people, but forgot to mention that the purpose of the legislation is to cut £1.45 billion from that budget in the next two years. If that is a mark of success, I despair of the Government's intentions in relation to other aspects of social security. We have had an interesting and wide- ranging debate, well supported by all my hon. Friends, and especially by the contribution of the hon. Member for Stratford-on-Avon (Mr. Howarth) which, as the Under-Secretary of State said, was greatly appreciated by the Government. It was
Column 202certainly greatly appreciated by Opposition Members because he fully supported our new clauses and amendments.
We would have had an even more interesting debate in Committee if the Government had not censored the membership of the Committee but had allowed a proper debate among people genuinely interested in the topic, with the knowledge and expertise that would have been greatly welcomed in our deliberations during our 35 hours in Committee. It is a sad reflection on that censorship that not one Conservative member of the Committee has deigned to turn up to speak on Report. 7 pm
By our proposals we simply seek information in terms of an annual report and a report on the appeals procedure to be presented to the House of Commons for proper parliamentary scrutiny. I find it incredible that a Government who claim to be the champions of open government should say that all that information will be gathered by the Government but that they will not present it in any coherent form to Parliament. One can only suspect that their real intention is to gather that information, recognise the realities of the way in which the medical test is operating and suppress the information, because they will not want a genuine debate in Parliament about the operation of the medical test.
The debate could not have made clearer why the medical test should be considered by us today--so that we could have a proper debate about the way in which it would operate in practice. The Minister has reaffirmed that the Government seek a clear threshold on which to base the decision whether someone is capable or incapable of work. It is clear from all the information--all the representations from organisations that represent disabled people throughout the country--that it is inappropriate to set a fixed threshold. Incapacity is a continuum. One needs to judge the nature of the illness or the nature of the disability against the real world of work. It is incredible to suggest that the Government could apply that medical test--which is not before us--to that concept of own work and all work without explaining the way in which all work will operate in the current employment market.
We must demand that information be presented to Parliament at the earliest opportunity. Reports on the way in which the incapacity benefit will work are crucial. We place clearly on record our total opposition to the Bill because, as all my hon. Friends have said, the reality of the Bill will not bite for at least 12 months. Then Conservative Members will come whining back to the House, as a result of their casework, and say, "We did not vote for this. We did not understand what would happen. We did not understand that the medical test would be applied in this way. We did not understand that there would be a reduction in the amount of benefit available under the new incapacity benefit compared with the previous invalidity benefit." We must say clearly, through the amendment, that we are voting to oppose the cuts in benefit to disabled people, and to oppose the tightening of the regime on the medical test and applying the reality of people with disabilities to a situation in which at least 3 million people are unemployed. That is what we are voting for. Let no Conservative Members return to the House in future and pretend that they did not understand what they were voting for. This is the opportunity to make their intentions clear.
Column 203Question put , That the clause be read a Second time : The House divided : Ayes 268, Noes 299.
Division No. 155] [7.04 pm
Abbott, Ms Diane
Adams, Mrs Irene
Ainsworth, Robert (Cov'try NE)
Anderson, Donald (Swansea E)
Anderson, Ms Janet (Ros'dale)
Ashdown, Rt Hon Paddy
Banks, Tony (Newham NW)
Beckett, Rt Hon Margaret
Beith, Rt Hon A. J.
Benn, Rt Hon Tony
Bennett, Andrew F.
Berry, Dr. Roger
Bray, Dr Jeremy
Brown, Gordon (Dunfermline E)
Brown, N. (N'c'tle upon Tyne E)
Bruce, Malcolm (Gordon)
Campbell, Mrs Anne (C'bridge)
Campbell, Ronnie (Blyth V)
Campbell-Savours, D. N.
Carlile, Alexander (Montgomry)
Clark, Dr David (South Shields)
Clarke, Eric (Midlothian)
Clwyd, Mrs Ann
Cook, Frank (Stockton N)
Cook, Robin (Livingston)
Corston, Ms Jean
Cunningham, Jim (Covy SE)
Cunningham, Rt Hon Dr John
Davies, Bryan (Oldham C'tral)
Davies, Rt Hon Denzil (Llanelli)
Davies, Ron (Caerphilly)
Davis, Terry (B'ham, H'dge H'l)
Donohoe, Brian H.
Dunwoody, Mrs Gwyneth
Eagle, Ms Angela