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Westminster Hall

Thursday 3 February 2005

[Mr. Edward O'Hara in the Chair]

Rehabilitation and Healthier Workplaces

Motion made, and Question proposed, That the sitting be now adjourned.—[Jane Kennedy.]

2.30 pm

The Minister for Work (Jane Kennedy) : I was going to say that it was an inspired decision of the Whips to choose this subject for discussion today, particularly in view of the fact that my right hon. Friend the Secretary of State published the Department for Work and Pensions five-year strategy yesterday, but the timing is entirely coincidental. However, it allows us an opportunity to compare and contrast the ideas that clearly exist around the House on this important issue. We will see what flows from the debate, which I welcome.

Since 1997, our central vision in government has been to create a Britain of opportunity and security for everybody. I know that that is a sweeping statement of the kind that generally makes people yawn, but it is more than a mere statement of aspiration. Back in 1997, we were criticised in some quarters and accused of irresponsibility for making full employment a key economic policy goal, but I would hope we agree that today we are closer to full employment in Britain than at any time for a generation. Unemployment is at its lowest for a generation and 2 million more people are in work than in 1997.

As my right hon. Friend said in his statement yesterday, this Government believe that an employment rate equivalent to 80 per cent. of the working-age population is achievable in the long term, but if we are to achieve that we face major challenges. Back in 1979, approximately 690,000 people claimed an incapacity benefit. It was not called that then; it was a different benefit and a different rate. By 1997, the numbers had reached 2.6 million. Today, they are in the region of 2.7 million. That equates to 7.5 per cent. of the working-age population, or three times as many as claim jobseeker's allowance. Most of those people have been on incapacity benefit for a very long time: over 2 million have been claiming it for two years and nearly 1.5 million have been claiming it for more than five.

Mr. Tim Boswell (Daventry) (Con): I am obviously sympathetic to the figures the Minister is using. Does she agree that, even if the national average is 7.5 per cent., there are areas and pockets where the percentage is very much higher and there is what might loosely be termed a culture of incapacity, which is itself part of the problem?

Jane Kennedy : I agree with the hon. Gentleman. I am glad to be debating this subject with him today, and we can explore it with less party particularity than would be the case if others were in his place. We can have a useful discussion and compare and contrast the strategies that we have all been developing as we look at this problem.
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I do not think we can genuinely say that full employment has been achieved when nearly one in every 13 of us is out of work and claiming an incapacity-related benefit. That not only represents a huge economic cost for the country as a whole, but places individuals and their families at greater risk of poverty and social exclusion. This is a challenge that is almost unrivalled in its complexity and sensitivity, but it simply has to be addressed if we are to win our fight for opportunity and social justice. To succeed, we must make a reality of that hackneyed phrase, joined-up government.

Mr. Steve Webb (Northavon) (LD): While the Minister is still speaking generally, will she reflect on the fact that the fastest growing group of incapacity benefit recipients is those who fail the contribution test? That number has risen by 300,000 under this Government. Those people, by definition, have no recent contact with the labour market. Do the Government have a parallel strategy to that work-related strategy to stop those people flowing on to incapacity benefit?

Jane Kennedy : Our primary focus is on people who would qualify for incapacity-related benefits, which means those who would qualify for the pathways at the moment. People who receive income support do not qualify: they would not come through the pathways and they would not necessarily qualify for the pathways programme when it is rolled out. That does not mean that they would not qualify for a range of support, but they would perhaps not formally come within the pathways regime.

Those people already qualify for support through the new deal for disabled people, and as we develop a more flexible approach to the work done through Jobcentre Plus and BOND—building on new deal—personal advisers in contact with such individuals will increasingly be able to offer a more flexible range of support to encourage and enable them to make early contacts with the workplace. They cannot maintain contact, because they have never had contact with the working environment or may not have earned sufficient for contributions to be paid.

Mr. Webb : The Minister is being very gracious with her time and I thank her for giving way.

I want to pursue the point a little further, as I have not grasped it. I think that the Minister has just told the House that the credits-only people—nearly 1 million out of the entire case load—do not go into pathways to work, yet they are the fastest growing group. Can she explain why someone who becomes incapacitated because of a bad back but does not satisfy the national insurance rules should not get the specialist pathways-to-work help, yet someone who comes from employment with exactly the same ailment and the same prospects of getting back to work qualifies? Why is there a different approach?

Jane Kennedy : I am advised that people on income support on the ground of incapacity are included in the pathways. I apologise to the hon. Gentleman: I had not appreciated that they are included because they get IS top up, and that top-up payment qualifies them for
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inclusion in the pilot. Therefore, they will be drawn into the new programme that we are to develop. I am grateful for the inspiration that has allowed me to correct that misunderstanding.

Mr. Boswell : I simply invite the Minister to confirm the impression I have now formed, which is that someone who is incapacitated but of working age will be entitled to the pathways, whatever the route or source of their benefit at that point.

Jane Kennedy : I am grateful to the hon. Gentleman for his helpful intervention. He is right.

Central to our strategy will be promoting the idea that we should all work in a healthier environment, enabling access to occupational health support, which includes quality rehabilitation services where appropriate. That is why the title of the debate, which refers to rehabilitation, was deliberately chosen, although our discussions will be much broader, given the wider debate on incapacity.

The objective of improving access to occupational health and healthier working environments represents an agenda that we share with employers, who need to deal with sickness and absence management and occupational health more proactively. We also share the agenda with the trade unions, which work to protect their members' health and safety in partnership with employers, and consider that an increasingly important role. We have a shared agenda with the insurance sector, which should be providing alternative and perhaps more positive routes of redress for those involved in compensation claims; for example, through employers' liability insurance.

We share an agenda, too, with the health service and especially with general practitioners, who deal with maintaining the highest levels of health for all and promoting well-being, including work as a health outcome. Equally, the Department for Work and Pensions has a clear agenda: supporting people on benefits to enable them to return to work. The effective co-ordination of all those agendas is crucial.

Mr. David Drew (Stroud) (Lab/Co-op): On the relationship with the health service, Standish hospital in my constituency sadly closed just before Christmas. I declare an interest: some us would like to take it over and do some work on rehabilitation. Ward D at that hospital was a rheumatology ward. During rebuilding about 20 years ago, a specialist flat was provided on the ward for people with rheumatological problems, to help them to be rehabilitated into their homes. Sadly, the flat fell into disuse. That seems to be quite a common story in the NHS. Will the Minister lobby the NHS to ensure that when people have rheumatological problems or osteoporosis, such occupational health support is provided? That provision should be part of all such wards, not an afterthought.

Jane Kennedy : I am interested in what my hon. Friend describes and I would like to hear more about that example, because I have a clear view that more could be done. We are in close dialogue with colleagues in the
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Department of Health about how occupational health and similar support services should be provided to people in work, and also on the possible reshaping of the culture and the advice that general practitioners and other health service practitioners give. Certainly, occupational health needs to be higher on the agenda in the training that GPs receive.

I have already said that this is a complex area and that there is an ever-changing range of issues involved, but our strategy can be articulated simply. First, it is about prevention: ensuring as far as possible a healthy society as well as healthy workplaces. Secondly, it is about retention: helping people who become ill or disabled to stay in the work that they are already employed in, where that is appropriate and practical. Thirdly, it is about intervention: giving active and positive support to those who become unemployed through no fault of their own and claim inactive benefits.

We believe that, with the right help and support, greater numbers of people should be able to retain their jobs or get back to work. What do we do about that and how do we stop large numbers of people who have worked, and perhaps could work, failing to do so?

Effective and timely advice and support would help people with common health conditions to manage those conditions before they became intractable. However, nearly 33 million working days are lost each year to occupational ill health. The Health and Safety Commission and I recognise the importance of improving absence management and increasing access to occupational health and return-to-work support. Such support could have an important impact on reducing the numbers leaving the labour market due to ill health, but only 3 per cent. of companies have access to or use occupational health or return-to-work support. That is a staggering statistic.

Employers, health professionals and the Government must all work together more effectively to create healthier workplaces and to play a bigger role in rehabilitation to enable more people to get into work and to help them to stay there.

The Health and Safety Commission document "Strategy for Workplace Health and Safety in Great Britain to 2010 and Beyond" is aimed at creating the right environment in the workplace and, in particular, at dealing with emerging health issues and the changing world of work.

We recognise that the Government need to provide leadership and practical support to achieve that ambition. Yesterday, my right hon. Friend the Secretary of State announced the Government's plans—alongside the extension of pathways to work—to develop and trial Workplace Health Direct. That is a Health and Safety Executive-led project, which will provide occupational health advice and support for small and medium-sized firms. It will be primarily a telephone helpline.

Workplace Health Direct is an important development that will make a real contribution to preventing incidents of illness and injury in the workplace, to managing sickness absence and to securing an early return to work. Those pilots will build on the considerable work that the Health and Safety Commission has already done in tackling sickness absence.
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The Government want to enable more people who have a health condition, impairment or injury to remain in or return to work for the benefit of everyone concerned. Offering appropriate and effective support is clearly critical. We feel very strongly that vocational rehabilitation has the potential to contribute to help us and other stakeholders to deliver those goals.

However, although there is good evidence on restoring function, especially for some specific health conditions, evidence on effective vocational rehabilitation is contradictory and inconclusive. We have already started to resolve that by improving the evidence base, and the job retention and rehabilitation pilots that we have discussed in the House before, as well as our evaluation of the pathways to work pilots, will provide important new evidence.

We intend to drive forward that work through the Department for Work and Pensions framework for vocational rehabilitation, which will act as a focal point and provide a mechanism to develop that agenda.

We are keen to increase the number of people with health conditions and disabilities who stay in work. However, as we discussed earlier, our immediate focus is on ensuring that significantly greater proportions of people on incapacity benefit avoid an unnecessary slip into long-term incapacity. The systems that interact with such individuals have so far failed to come together and work to their mutual benefit. Were those individuals given good return-to-work advice from the outset from their employer or their general practitioner? If they were equipped by the NHS to manage their health problem, and perhaps pressed by the Department for Work and Pensions to address any obstacles they might face and helped to find work, I am sure that employment outcomes could be massively improved.

That represents a fundamental transformation in how people with health conditions who are not working are treated. Everyone with the capacity to get back to work should be supported, and helped to recognise their capabilities and responsibilities. The main way in which we are taking forward reform of the systems of supporting such people is the pathways to work pilots.

I do not know whether hon. Members have visited a pathways pilot, but we are implementing a completely new framework that starts to get claimants and all key stakeholders together. In particular, we provide support from a highly skilled personal adviser when people can most readily be helped back to work—primarily, those first weeks and months as they begin to claim benefit. However, it is gratifying to see in pilot areas such as that represented by my hon. Friend the Member for Ogmore (Huw Irranca-Davies), who is sitting quietly behind me, almost 1,000 people who had been on benefit for a long period volunteering to participate in the pathways to work programme.

We also provide groundbreaking NHS rehabilitation support, so that people can learn to manage and cope with their health condition—the condition management programme. Again, this is a revolutionary approach to encouraging people to think about their health condition. There are elements of the expert patient programme that the NHS has had in place for some time, but this is much more proactive.
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Mr. Drew : I thank my right hon. Friend for giving way again; she is being very generous. She may be coming on to the important issue of companies that choose to test their employees for both alcohol and drugs use—or, dare I say it, misuse. Have the Government a clear perspective on whether that would be appropriate if counselling and support were available to employees who were deemed to have a problem? Is that something that we should be encouraging in the world of work?

Jane Kennedy : There are clear arguments for some employers to do the testing that my hon. Friend talks about. In some occupations, there is a prudent case for it. However, as he rightly points out, when a problem with an employee is discovered, the proper approach is to work with them to overcome it. I am confident that the best employers are developing that best practice. That was not an area that I was going to touch on, but I am grateful to my hon. Friend for drawing it to the attention of the House.

Through the pathways, we have developed strong local partnerships with the voluntary and private sector employment advisers of the new deal for disabled people. This is where the policy outlined by my party and that of the hon. Member for Daventry (Mr. Boswell) almost coincide. There is a certain overlap in our objectives, although his party is driven down this route by ideology rather than what is practical in the circumstances, and I look forward to hearing about that shortly.

We have encouraged part-time work and work trials for people in receipt of the benefits in pathway areas, and introduced a return-to-work credit, so that it always pays to get back to work. We provide in-work support to help people to manage the transition back to work. Finally, we are working with local GPs in the pathways areas to help them to understand the importance of avoiding long-term absence from work from a patient care perspective.

The totality of our approach is based on best practice from occupational health research and clinical management. The research shows that early intervention and modified work in the workplace are two of the most effective tools that we can devise to enable people to remain in or get back to work. These are early days, but the approach appears to be paying off. Jobcentre and health service staff have responded well to the new service. We are already starting to see the fruits of that response in the number of people being helped back to work. Anyone who visits a pathways area will be profoundly impressed with the enthusiasm of staff as they engage in the complex and sensitive role that they are being encouraged to undertake.

Mr. Webb : The Minister makes a strong case for the success of the pathways to work pilots, and the five-year plan that was published yesterday includes a graph that shows that incapacity benefit outflow rates are enhanced in pathways areas. Therefore, I am puzzled why the Government are not applying the scheme everywhere. Why are they rolling it out to only a third of the country and why will that take some years? If it is so wonderful, surely we should be doing it for everyone now.
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Jane Kennedy : We are still in the early days of testing different methods of engaging people in the pathways areas. Not all pathways areas are offering exactly the same package of support. For example, in one area, to test what worked, the first contact that personal advisers had with individuals was a mail shot. In another area, first contact was made by an adviser telephoning the individual, talking them through what pathways was, and following it up with a mail shot inviting them to an interview. Perhaps unsurprisingly, the response to the second approach was much more positive from those in receipt of the benefits.

We are still testing to see what works best and what gives best value for money in what is a resource-intensive approach. We need to be sure that, when we expand the scheme across the country, we expand the most effective and appropriate approach for the customers whom we are dealing with.

Mr. Boswell : I am glad that the Minister is taking into account the evidence of pilots, because that has not always been her Department's practice. However, if her case for not rolling out the pathways scheme nationally is that she does not yet know which is the best model, although she has indicated that some evaluation has already taken place, can she tell us when she will back a particular model, with the inference that it will be adopted nationally?

Jane Kennedy : We intend to roll out the next phase of pathways areas this October. That will consist of four or five districts. We will roll out beyond that in the subsequent six months.

Over the next six months, we aim to put in place the framework that works best, but we will continue to test other ideas as we proceed. From talking to staff in the pathways areas, I have no doubt that, even as they work, they continue to think of new ways of engaging with people. The project will evolve as we develop it. I am grateful to have the time to do that. We will reform the whole structure of support. Legislation will be required to do that. The time involved in debating and consulting on the legislation and taking it forward will allow us to continue to test what is the best way of enabling people in this group to return to work.

Mr. Drew : Will my right hon. Friend give way?

Jane Kennedy : I shall describe some of the outcomes that we are already getting after I have given way to my hon. Friend.

Mr. Drew : My right hon. Friend is being more than generous.

I take a close interest in those with mental health problems. I work with a group of mental health practitioners; by chance, I am meeting them tomorrow. I am interested in how people who have had mental health problems get back into work, often via the stepping stone of the voluntary sector. It would be good to know that employer perceptions of people with mental health problems are changing, and I think that they are. One would also like to think that the public sector is better than the private sector, but in my experience that is not always the case. Is something
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going on in the particular projects that have been talked about to examine the needs of those with mental health problems? They are often the most difficult people to get back into work, but they do want to get into work.

Jane Kennedy : I agree. Not only do people who have mental illness in their background often prove to be the hardest to help, but employers sometimes have a high degree of suspicion—if we want to call it that—of such people. Often, they are particularly reluctant to employ them.

In the pathways areas, condition management programmes and the interaction with the health service enable support to be tailored to the circumstances of the individual. I have met people in Blackburn, in the east Lancashire pilot, with the background of a mental health condition.

2.57 pm

Sitting suspended for a Division in the House.

3.11 pm

On resuming—

Jane Kennedy : I talked earlier about the enthusiasm that Jobcentre Plus staff were displaying, the partners involved in pathways areas and the response that we have had as a result. Hon. Members will have seen the five-year strategy. It draws attention to the fact that, in the pathways areas, the improvement in the number of recorded job entries is about double the improvement in other areas. In pathways areas, six times as many people take up further help to get back to work compared with the national average. There is between an 8 and 10 percentage points increase in the rate of people coming off incapacity benefit after four months of their claim compared with non-pilot areas.

To the end of October 2004, we estimate that the pathways pilots have helped more than 9,000 people into work. All those encouraging signs are why we have determined that the pathways project is the way to assist people who are in receipt of benefits to return to work.

On 2 December, the Chancellor announced that the pathways to work scheme would be extended. We have discussed how that will be done to cover about one third of the country. The pathways approach will be available to about 900,000 people on incapacity benefit.

A considerable amount of work is under way, which is beginning to have an important and positive impact. It is important to ensure that we maintain momentum and build on the progress so far. This is the right time to consider change. The proposals set out in our strategy plan are the right starting point to create a better model for people who are at risk of losing their job, or who have difficulty finding one because of ill health or disability.

I reaffirm what my right hon. Friend the Secretary of State said about the principles that will guide our work. He said that for those with a health condition so severe that a return to work would be very difficult, we will provide real financial security for the long term. For those who can work, we want to provide the right help and support to get back into work, while offering the right rewards for engaging with the labour market.
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I hope that I have made it clear through this fairly broad speech that this is not just about reforming incapacity benefit. We need a concerted effort to make changes on a number of fronts if we are to maximise the opportunities for people with disabilities and health conditions not only to stay in work, but to return to it. I will be interested to hear from the hon. Members for Daventry and for Northavon (Mr. Webb) in particular what their alternatives are. Constructive criticism is always welcome, but new ideas will also help us as we take forward this big project. I look forward to hearing the rest of the debate.

3.14 pm

Mr. Tim Boswell (Daventry) (Con): I thank the Minister for introducing the debate and for the tone in which she did so. She sought to de-fang any criticism; there will be a little later on, but it is right that we should have a constructive debate about important issues.

I am also glad that the Government initiated this debate. When they did, I was initially a little puzzled, although matters became clearer yesterday. Of course, I accept the Minister's assertion that the debate was not timed to phase in with the five-year plan announcement, which we shall be pleased to discuss on the Floor of the House.

We debated the Health and Safety Executive in this Room only a couple of weeks ago, and I wondered whether we were going to replay that debate. We might have had the famous speech made by a parliamentarian in the 18th century, who said "Ditto to Mr. Burke", and then sat down. However, this debate goes wider, although there are important linkages. I hope that the Minister will allow me to expand on my thoughts about healthier workplaces, which she did talk about.

If I may, I shall begin with a particular—the rehabilitation issues—and move on to the general. I do not think that inappropriate any more than I think the title of the debate inappropriate, because there is a strong community of interest. Some rehabilitation issues for people with disabilities or medical conditions are equally applicable to persons who are hard to place, and who may have been involved in incidents that mean that they require rehabilitation in some sense. An example would be alcohol abuse, to which the hon. Member for Stroud (Mr. Drew) already referred.

I would argue strongly—as I always have done on disability issues—that if employers generate an environment that is friendly towards disabled people then, almost ipso facto, it will be a better workplace for everybody who goes there. We should not think of that as being antagonistic, and we should not think that making special provision does not make it necessary to consider wider issues; it should all go together. I do not know whether the Minister has yet seen Ford's Mobility and General Information Centre at Swindon, where people are advised on car modifications and so forth. It is a showpiece site. I went there two or three years ago. It is exemplary, and a very attractive place for anyone to work, not just the 40 per cent. of the work force who are disabled. Those are general points.
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If I express a certain enthusiasm for the issue of rehabilitation, it is because I have taken a personal interest in it over a number of years.

Jane Kennedy indicated assent.

Mr. Boswell : The Minister is kind enough to nod, but it is genuinely the case. I have done some work with the British Society of Rehabilitation Medicine. A few years ago, when the Department was beginning to get into the swing of preparing for pathways, I peppered the Minister's predecessors with a healthy number of parliamentary questions about rehabilitation issues, some of them arising from British Society of Rehabilitation Medicine reports. I think that the matter is of general importance.

The moves that the Government have made are desirable in principle, even if we do not necessarily agree with them all in detail. They may certainly be described as being in the right direction. If nothing else, we have established a common understanding that there is a problem, and that it has to be attended to, often in detail. Above all, it must be done with reference to the interests, needs and requirements of the individual, rather than by taking some sort of global approach that will leave us with a solution for the global situation.

In the spirit of the debate, I will quote verbatim from the Secretary of State's statement yesterday, because I agreed with him so much. He said:

That is not the voice of some Victorian employer; it is a perfectly reasonable clinical judgment—something that I think we all know more about now. It echoes our own experience. People retreat into hopelessness, and that does no good to them, the economy, the Treasury or anybody. We have to find ways of unlocking their despair without censuring them or playing cheap tricks, and we should provide practical help.

The Minister will have heard the exchanges between the Secretary of State and my hon. Friend the Member for Havant (Mr. Willetts) across the Dispatch Boxes yesterday, and I do not think it necessary to reproduce them all here. Of course, I agree with my hon. Friend, and I think it right that Ministers should justify their policies. They need a little justification, and I shall explain why.

The Minister made the point that there had been a welcome increase in employment and a reduction in unemployment. She boasted about that and I do not blame her for doing so. However, it is incumbent on her to ask why, when there had been a big historic increase in the numbers of people on incapacity benefit under the previous Government, the present Government are now apparently complacent about the stasis in those numbers since they have been in power.

Whatever the explanation is—and we do not want to have a general economic debate here—despite the fact that there have been several years of strong employment, the numbers on incapacity benefit have stuck, or slightly increased and so far there is no real sign of a reduction. Perhaps we will begin to see some improvement, but we have not seen it to date.
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Jane Kennedy : Does the hon. Gentleman accept that the fact that the rate of increase has dropped off remarkably since 1997, that a large number of people have gone into work—partly through the new deal for disabled people and partly because there is more opportunity to do so—and that we have developed pathways and are piloting that approach, already indicates that we have not accepted a degree of stasis around this policy area?

Mr. Boswell : I accept that the Government have done something. However, they have also announced quite a lot, which was the substance of the remarks made by my hon. Friend the Member for Havant yesterday. Not much has got better yet. There have been initiatives, there are now more and we all hope that the Government mean it this time and will carry the current initiative through. If they have collected evidence under pathways, and so forth, and find out what works, I shall be the first to cheer.

First, I want to register a note of reservation about whether there has been an improvement to date. Secondly, in order for there to be a real improvement, the Government and the system generally—although the Government will have to drive, or manage, the process—have to have all their ducks in a row and ensure that all the agencies, rather than some of them, are contributing to dealing with the problem. They have, particularly, to avoid any tendency to perverse counter-incentives, which my hon. Friend mentioned yesterday. I will touch on that again in a moment. That is particularly the case where people may be reluctant to go off benefit because they may feel that any return to it—if their attempts to work prove unsuccessful—may result in their having to come in at a lower rate. That is a serious issue for any Government.

I need to record that the Government are not intending to introduce the system until 2008; the Secretary of State's phrase was that its main elements would be in place by then. We still have quite a long time to wait for the system, let alone the time that is required to evaluate it. Indeed, there was some rather strong briefing in today's press, saying that it would take many years—over a decade and perhaps up to 20 years—before there were significant inroads into the number of people on incapacity benefit. If one takes a conventional target of, say, taking 1 million people off the benefit, which would still leave 1.7 million on it, and if it will really take 20 years, progress will be glacial. If the process goes in one direction and is making progress, I will not object to that, but the rate of progress needs to be looked at and accelerated if possible.

In saying that, I realise that that there are still some real questions to be asked and definitions to be found, which, no doubt, will have to be consulted on. That may be behind the Department's reluctance to rush forward into the new strategy that was touched on yesterday and to which the Minister of State has spoken today.

3.24 pm

Sitting suspended for a Division in the House.
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3.35 pm

On resuming—

Mr. Boswell : I was saying to the House that my point was about difficulties that the Department will have with decisions to be made.

One difficulty will be to find a functional distinction between those who are entitled to a rehabilitation benefit and those who receive the higher-rate disability and sickness allowance, because the latter are in a particularly difficult position. We all understand the kind of distinction that the Minister is making. Whether she will succeed in putting such a watertight distinction through remains to be seen.

The second issue is whether or not people—particularly disability interests—will accept such a distinction. There are already signs of a good deal of disquiet about what was announced yesterday, which no doubt she will have to consider in due course.

From that, I pass onto the major constraints on rehabilitation services. I use that term generically, in the widest sense, including not simply medical rehabilitation but also what might be termed social rehabilitation—support for people returning to work and, more generally, the mechanisms for doing that.

The first question, a reasonable one, is whether the rehabilitation services are in place. The answer, I think, is that they are fairly patchy, do not always operate to the same extent and are not always easy for potential clients to be referred to.

Taking a specific area—which is still a significant component of the total, as the Minister will know from the incapacity benefit figures—it has been reported only today that there is, if I may use the word, an acute shortage of NHS facilities for rehabilitation of people who have broken down in work with cardiac or circulatory conditions. That is the sort of difficulty created in establishing the pathway for a return to work.

I will give another example from my own constituency. A number of years ago, in the course of visiting, I was talking to a police officer, who was off work because of an accident in which their cartilage was injured. At that time, although I have no reason to think that that is applicable now, the waiting list for consultation at the general hospital was 72 weeks. Effectively, that was at least two years of highly paid and skilled manpower being denied to the police service while the national health service failed to provide the necessary facilities.

Our wish is to reinforce the Minister in any representations she makes on the provision of facilities to her counterparts at the Department of Health and to the management of the NHS. What would happen to claimants who were prepared to accept a course of rehabilitation but were then unable to access one and, therefore, continued on benefit beyond a certain time? Any risk of a benefit cut for not having accepted rehabilitation owing to matters beyond their control would be objectionable.

My second question is about the interaction of the health service—rehabilitation—with a wider range of social provision. That could, traditionally, be social services, departmental responsibilities or work schemes, which most of us know are sometimes a little difficult to
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get to and sometimes said to be bureaucratic, but are clearly important. They provide the mechanism at work and the safeguard or assurance to the employer that that will be provided.

A third issue is that of special cases. I am particularly thinking of conditions that may fluctuate—that may relax or remit. The hon. Member for Stroud has rightly reminded the House of a major part of the incapacity benefit problem—mental conditions. A whole range of physical symptoms and mental attitudes and conditions can make it difficult for people to know whether or not they will be confident in returning to work. Special attention may well be needed, even in relation to the benefits system itself.

I turn to the question of the effective management of cases. I was in conversation only a few moments ago with a colleague who has knowledge of the pathways system, who expressed the concern that, if anything, there was a concentration within Jobcentre Plus, rather than an extended use of outsourcing. That reflects what was said in conversations with some of the private sector providers.

The Minister was generous enough to say that in some respects the thinking of my colleagues who specialise in the rehabilitation side now and of myself in wanting to use the private sector might be consistent with her thinking on this matter, but she went on to fall below that comment by suggesting that there was an ideological basis for that. To borrow the Prime Minister's phrase, so far as I am concerned what works is best. That is important. I say to her, not in an ideological way, that there is a good deal of evidence, particularly with regard to people who are severely disabled or hard to place for other reasons, that the services of specialist providers from the private sector—as that is generally interpreted, so that it includes many people from not-for-profit organisations—can be invaluable, and that, in the Minister's terms, they could supplement the work done by the public providers.

From the days when disability was my lead responsibility, I still have a worry about the idea of personal mentors—not, of course, because they do not work hard—or, indeed, of disability employment advisers. Sometimes, it is important to have access to the specialist service that can deal with the particular case. We all need a GP, but we also need to be able to get to the specialist if that is required.

Jane Kennedy : Let me explain one of the things that puzzles us about the hon. Gentleman's "opportunity first" proposals for IB. It is easy to understand the proposal to use entirely the voluntary and private sector, but we do not understand how using those sectors—and, largely, the new deal for disabled people—will achieve his party's objective of having 900,000 people moving into work over a four-year period. What will have to change in the new deal for disabled people to enable the private and voluntary sector to make that difference?

Mr. Boswell : I might refer the Minister to the basic principle that we adopt in this, which is that there should be an encouragement to voluntary and private organisations to help those on incapacity benefit to find work. The essential issue is the nature of the contracts
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and incentives, and the run-on incentives over a longer period, for securing placement; we might need to debate that on another occasion. From my own work and studies in relation to hard-to-place individuals without disability, I have uncovered a lot of interesting comments and input from experts in this area. Some of that has also been made available to the Minister's Department, and I have no problem with that. Those experts would say that the whole issue inheres in the contract structure.

We will not resolve this matter this afternoon—and, as the Minister has suggested, nor will we resolve the ideological issues contained in it. However, she needs to take a hard look at the pattern of those contracts to ensure that they provide people with the best possible pathway and incentive to place. There is a tension— not a difficulty—that has to be resolved. This might not work if she simply does things on the basis of a gateway assessment by saying to the training or rehabilitation provider or placement person, "This is a hard-to-place person, or a severely disabled person, and it will cost you, so you had better have more money up front". What one has to do is provide a reasonable population of cases from which it is possible to make placements, and for the system to give proper acknowledgment of and remuneration for the placements of those people who turn out to be the hardest to place. That is a long debate to which we shall no doubt wish to return another time.

I have one other point for the Minister on rehabilitation issues, which goes slightly wider. We need to consider whether the benefits system helps or hinders the process. I touched on that in relation to incapacity benefit. One of the better things that the Government did a few years ago was to relax the linking rules, but that is not sufficient to deal with the difficulties of some intermittent conditions in particular. Certainly my experience as an employer, which the Minister knows is in agriculture, has been of many people who are off sick, but not after suffering a serious and disabling accident. They are, however, temporarily unable to work. At some point they may feel that they could work, but they are still on benefit, and formally doing something as simple as getting on to a tractor and seeing whether it is possible to stretch a leg and to work comfortably for a couple of hours without pain is, in itself, a breach of the benefit conditions. That needs consideration.

I used to use an analogy relating to a rather shocking photograph that appeared in the press many years ago. The piece showed just a key and said, "This is the key that controls the nuclear deterrent. It has two positions: the top position is peace, and the quarter turn gives you war." In rather the same way, the Department has traditionally taken the view that someone is either ill and on benefit, or fit to work and working or available to work. That view is being softened, but the transition from one to the other is to be encouraged and, above all, should not be subject to sanctions.

That is what I wanted to say to the House on rehabilitation. On transition, quite a lot of the debate has a wider application to persons who are hard to place, persons who may need other types of rehabilitation and persons who may need help, encouragement or mentoring to get into work. The issue goes wider and relates to people's workplace
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existence too. For the process to work, we need a public discourse that is alert to the issues and we need all people moving in broadly the same direction.

The first issue is a safe workplace. That relates partly to persons who might have an accident at work. Too many still do, which is always regrettable. Such people might incur a disability as a result, which would put them off work. The issue also relates to persons whose health condition may deteriorate while at work. I have always said on rehabilitation issues that almost the most important thing that employers and, I hope, their public sector support can do is to ensure that people are protected in work and that the necessary adjustments are made—that "access to work" or whatever is appropriate cuts in, which need not be at excess cost—rather than simply letting people go sick and disappear from the labour force. That is important.

The wider issue, to which the Minister referred, is the management of sickness absence more generally. I am pleased that she is considering that in relation to the public service. I remember vividly a conversation with my then local chief constable. His police force, like many others, had resource difficulties, partly because of pensions obligations. I talked to him about sickness absence and he said, "We have actively managed that and now have a particularly good record, almost an exemplary record." All employers, in the private and the public sector, should be doing that. It has nothing to do with forcing people to work when they are not fit to do so and with encouraging presenteeism. It is about saying, "Let's find out what the causes of sickness absence are and whether we can take them, as far as possible, out of the system."

With regard to all these issues of workplace safety and attitudes to creating or protecting a healthy work force, there are three categories of employer. Some are exemplary; they are closely involved with all the issues. They are probably in the 3 per cent. that the Minister mentioned, who run their own occupational health scheme. Other employers will be delinquent, and I hold no brief for them, but many employers, including some small and medium enterprises, will be in the middle and it is important to give them the right kind of incentives and encouragement. I welcome the fact that the Health and Safety Executive is anxious to participate in these issues and to advise, as well as admonishing or regulating.

There is an important need throughout industry—public and private sectors—to integrate risk management with the regulatory environment. In some cases, that can be reinforced by market factors; there is a strong business case for a healthy work force. As the Association of British Insurers pointed out in its "making the market work" initiative, it can be helpful to ensure that employers get acknowledgement for the health of their work force and that they do not pick up the tab of the average performer. The management of the workplace must also be considered. Those issues are all related to securing a healthy work force.

Further on in that train of thought is management of the claim, which we must ensure is not spun out or attenuated by a poor claims-handling process, often to the great distress of the claimant. Whenever possible, there must be some understanding of the importance of
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the mutuality of interest in the mediation process. Then we loop back to the rehabilitation side. It is no secret that many of us looked with interest at the American model of workplace insurance, because it puts the economic incentives in the hands of the insurer, who has the difficult choice of whether to pay out benefit or to provide rehabilitation services. That model does not necessarily translate literally to the United Kingdom context, but it is an example of the blending of regulation and the use of market forces and reputation to try to drive towards a better conclusion.

I have already mentioned the interface between the Minister's Department and the Department of Health in the provision of rehabilitation services, but I want to relate it also to organisation. I used to take what I thought were easy, if not cheap, tricks from the Minister's predecessor by saying, "Ah, isn't it interesting? If you are concerned with vocational rehabilitation, that's your Department, but if it's occupational health, it is the Department of Health." At that time, workplace safety came under the then Department of the Environment; we got two under the same roof, but not three. I do not ask the Minister to magic that little distinction away overnight, and there may be reasons for not doing so, but it is terribly important that in addressing these issues the Minister does so in genuine partnership with the Department of Health, not least because otherwise it will not carry credibility with the private sector.

I would like the Minister to say a bit more about the national framework for vocational rehabilitation and how it will be affected. I would also like her to say something about the integration of activities with the occupational health strategy in the Department of Health, which I accept go wider than the workplace. It is interesting that that Department is still offering NHS Plus as an occupational health service. The Minister's Department, through the Health and Safety Executive, will offer the workplace Health Direct, and I would very much like to know how they will tie up, if only because employers will get confused if they do not understand where to go.

In conclusion, I want to say a word about wider occupational health issues involving the work force as a whole, and to get away from rehabilitation as a detailed issue. As I said in this Room two weeks ago when we debated the Select Committee report on the work of the Health and Safety Executive, it is fair to say that health is now as important as safety. I hope that no one will misinterpret that as a vote against safety, which of course it is not; it is a serious comment on the need to upgrade the importance of occupational health. There are important elements, some of which were identified in that debate, which we all need to bear in mind, particularly in relation to the changing character of the work force.

There are more women in the work force. The Minister will have seen today's interesting Equal Opportunities Commission initiative on women who are pregnant at work. I could and would not condone people being sacked, in defiance of law, for becoming pregnant. It worries me that employers still think that an appropriate thing to do. There is more self-employment, which can create difficulties, more contract employment and there are more migrant workers. The situation is far more complex. The
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Beveridge model of a man working in a factory environment with large numbers of fellow males in extended employment, from apprenticeship to retirement, has evolved for the better. However, that means that earlier appraisal of problems is more difficult. That is accompanied by a change in the pattern of risk and the kind of occupational issues that arise.

As most farmers know, it is still possible to damage one's back or pull something by lifting too much or badly. We should never forget that manual work still takes place and must be carried out safely. However, many people do not experience such work. They may work in an office and be worried about repetitive strain injury or sick buildings. The fact that the risks have shifted does not mean that they are not significant, and that emerges from the incapacity benefit statistics on the changing nature of the work place, which show that there is as much stress as muscular-skeletal problems, and cardiac problems are not far behind as major causes of sickness in working age.

I say to the Minister firmly that we on these Benches want to use all available resources. The expertise, enthusiasm and resources of the private sector should be used to the maximum effect. It is also important to ensure that both sides of industry—employers and unions—are engaged in an active programme to improve the quality of life in the workplace. The Government must consider their role in leading a partnership model. We will not agree about how that is to be delivered, but I think and hope that we will agree that there is an essential problem of people not working when many would wish to, and of incentives not getting people back to work. There is also a wider underlying problem about whether workplaces are the places we would like to work in.

The problems will be solved neither by anybody grandstanding here, nor solely by government initiative, and certainly not by opposing the inclinations of the private sector. We must show that it is in the best interests of employers as well as workers and taxpayers to ensure that the approach is understood by all parties and that we bring our own thoughts to the debate and reach a better conclusion than we have so far.

3.59 pm

Mr. David Drew (Stroud) (Lab/Co-op): I am delighted to take part in this debate. I feel a bit lonely at the back here, but I would like to think that the debate is about quality rather than quantity. Some of my colleagues have missed an opportunity. Perhaps the debate should have had a slightly different title, because if we had done a vox pop on what my colleagues thought would happen this afternoon, we might have got some interesting answers.

Although the title may sound nebulous, this is a vital issue, not only because of yesterday's announcement by the Secretary of State, but because it gets to the crux of what I believe is the good part of this Government's programme: getting people back into work and giving them quality of life and hope. More than that, it concerns what most of us think about day in and day out, which is what we do in our place of work, the appropriateness of that place, whether we enjoy going to work, whether it is worth getting up in the morning to go to work and the links to what we do outside work.
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I shall come back to that point, but, given your liberal tendencies—not with a big 'l'—Mr. Deputy Speaker, I would like to talk about what I see as rehabilitation, which involves how people live their lives at home and how that affects their ability to go to work.

I make no apology for starting—partly because I received a briefing from the Chartered Society of Physiotherapy, as, no doubt, other hon. Members did, so I shall not read from it—by paying tribute to those who work in that area, whether physiotherapists or occupational therapists, community psychiatric nurses or mental health teams. As I said in an intervention, I am interested in the problems of mental health. Those professionals are trying to do their best, sometimes in difficult circumstances, to give their clients a quality of life and to move on. So often, people with mental health problems get stuck in a rut and find it difficult to move on. Judging from all my experience, apart from those who really are disabled and see no way of overcoming their disability, the vast majority of people genuinely want to improve their quality of life, largely through their ability to earn income. Of course, that starts and ends with whether they are capable of going to work. We must consider this in the round.

As I said, I make no apology for starting with a matter that has not been touched on as much as it might have been. That is understandable: where do we start with this debate? Where people live affects the rest of their lives. I have always been a strong believer in home improvement agencies, and I have been a member of the Stroud Care and Repair Board for more years than I care to remember—certainly for more than the last decade.

I have seen at first hand how small repairs to people's homes allow them to stay at home, which, of course, means that they are much more likely to be able to stay in work. It gives them a quality of life, which, for a cost of a few hundred pounds—sometimes less than that—makes an unimaginable difference. One of the problems is the laborious process of engagement with such schemes and how to gain access to the improvements that we all know are needed.

Whether people are in public sector housing, including housing association stock, have their own property or rent privately, there are some difficult hurdles to overcome, not least getting an occupational therapist to do an inspection.

The hon. Member for Daventry (Mr. Boswell) was right to talk about how long it can take for somebody with a physical injury to get a physiotherapist. I am talking about people needing adaptations to their property, which is just as important. It is, dare I say it, even more "in your face" and it can have an enormous, depressing impact on people's ability to organise their lives. They can put up with the pain, but not with the fact that their house is completely unsuitable, they live in one room and they cannot do the garden. They gradually draw into themselves—perhaps giving up work, perhaps becoming incapable of getting back to work. I put that on the record because it is important that we consider things that really matter to people. Home accommodation cannot be separated from work accommodation.

I pay due regard to the trade unions. I have already mentioned the Chartered Society of Physiotherapy, which is a trade union of physiotherapists. I would also
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like to mention my own union, Unison, and some other manual workers' unions such as the Transport and General Workers Union and the GMB. I pay tribute to the fact that they are very interested in this issue. The Fire Brigades Union has a long track record of having to deal with members who have been injured at work, as a result of their work or because of general wear and tear on their bodies.

That has an acute resonance because of the pensions issue and the fact that, understandably, the Government are considering how to face up to it. We may have some arguments about how they have gone about that so far, but we cannot duck the issue. It relates directly to how and where people work and whether they are able to stay at work.

Since I was elected nearly eight years ago, I have always made a point of saying that the difficulties caused by early retirement are coming home to roost. Sometimes, no doubt, Ministers would prefer that I had not done so—I am sure that they would prefer to be deaf to what I am saying. Sometimes, people take early retirement for positive reasons. It would be nice if we could all take it, but things are going in the other direction. However, people often take early retirement for negative reasons, usually because they are not capable of continuing to do their job or they have been injured or suffered some problem.

As a former teacher, I think that teachers have a certain view of how hard their job is. Looking around, we do not see many teachers reaching the age of 60 in their job because of the arguments that they always advance to me: the stress in the classroom and worsening discipline. I do not agree with that, but I know that teaching is a very stressful job. All those things come together: if people do not value the quality of the job and the workplace—that is directly what this debate is about—they will leave. We have to improve the situation because, quite simply, we need them to do the work. We cannot afford for them to continue to leave in such numbers. More particularly, we need their expertise.

It is a disgrace to the public sector, but also to the private sector, that we have devalued older workers. I very much welcome what we have done on age discrimination, but one of my friends, who is 67, gave me a real flea in the ear at a party meeting on Friday. She said, "It is all well and good, but I am 67 and you have protected me only up to 65. I want to work. Why am I not allowed to? Why is it that when I put my name forward for a job, I get no protection at all?"

I know that on this issue, as with anything, the glass is half full or half empty. That lady feels strongly that it is half empty. We have gone part of the way, but she wants to work and feels that she is being prevented from doing so because she gets no protection. We have to face up to that issue. As much as the general view is that most people want to leave work at the earliest possible opportunity, there may be strange people out there—although my friend is not strange at all—who feel that work is important. My friend does not have a pension to fall back on, so she must find other ways to bolster her income on top of the state pension. That, too, is worth putting on the record.
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Stroud being Stroud, it is not one of the pathway areas. However, to be fair to my right hon. Friend the Minister, I would like to give plaudits to Jobcentre Plus for the work that it has already done, particularly on mental health, which I am interested in. It has worked hard to find ways of helping people to make the transition back to the world of work. There are some good examples of that, but I do not have the time to refer to particular cases. The general feeling is that things have got better, but that they still need to get a lot better to make a difference.

That impinges on another aspect to which we should pay due regard—the work of the voluntary sector, which we often take for granted. I always argue the case for compulsory volunteering. Some people laugh at that and some think it is a completely ridiculous notion, but I believe that everyone should be a volunteer. Even if they spend only half an hour a week volunteering, it is good for the soul.

The hon. Members for Daventry and for Northavon (Mr. Webb) will know, because we share the same faith, what we think the role of people is in terms of trying to do things for others. I think that volunteering is important because of what it does to the individual and the way it builds their self-esteem, as well as being fundamental to keeping our society going. Without the work of those volunteers, our society would collapse. It would be interesting to know which would be more damaging—the collapse of statutory employment, leading to mass unemployment on a scale that we have never seen, or the voluntary sector saying, "We are not doing this any more." The role of the voluntary sector in this area is very important.

That is a link back to mental health, and the work that I have done in that area. In that context, I will mention a particular organisation and an individual who has taught me an awful lot. The organisation is Scout Enterprises, which works with people recovering from mental illness, and the person is Chris Gascoyne who, over a long time, has taken me through the case histories of people who have lost jobs on the back of a period of mental ill health, explaining the importance of rebuilding their confidence. That can be done only by arranging for them first to work part-time in the voluntary sector and then gradually reintroducing them to a more formalised setting. There are some wonderful examples of how people have got back into full-time employment, even if they have not gone back to the jobs that they did previously because that would be too difficult.

The role of the Department for Work and Pensions is to be as sensitive as possible in devising a benefit system that gives people incentives, rather than imposing penalties, so that they can take their time. Moreover, there must always be a safety net. The one thing that people with mental health problems or other conditions such as ME—I see that there is a reception next door on that topic—really want to know is that if things do not work out, there is a net that will catch them. If they fall through the net, we all know that that could be it and that they might never get back into the world of work again.

I welcome this important debate. I made three interventions earlier and I shall finish my remarks in relation to what I said in the first of those concerning the relationship with the NHS. The Department for Work
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and Pensions is doing some exciting work, but that will pay dividends only if we can lock it together with the NHS being more proactive in how it works with people to deal with the matters that the hon. Member for Daventry spoke about.

The NHS must cut waiting lists so that people can get treatment much more quickly, but, in addition, it must rediscover rehabilitation—some of us used to call it convalescence, but the NHS does not seem to like that term any more. People need time to recover, and then help to move back. I gave an example of how that is important in relation to where they live, but I also want to talk about how they get back to work.

The NHS must be better at rehabilitation. It cannot just examine the physical bearing of the individual, but must consider how it can help their mindset. It should also consider the fact that much more investment in occupational health and things allied to it could give people back the confidence that they can achieve the things that they might have achieved but for events outside their control, where things have gone wrong.

I hope that following this debate the Minister will be involved in Cabinet Committee discussions with the NHS and Department of Health Ministers to consider how we can make this situation better. All sorts of Departments could be linked in, but I highlight the NHS because it is the most important nexus. If that were to happen, we could say that we had achieved rehabilitation and healthier workplaces.

Mr. Steve Webb (Northavon) (LD): It is always a pleasure to follow my constituency neighbour, the hon. Member for Stroud (Mr. Drew), whose contributions are profoundly humane and thought provoking. They have broadened the scope of what we have been talking about this afternoon. I could not help reflecting that his 67-year-old friend who sees a half-empty glass is being an optimist, because we have not even got age discrimination legislation yet.

4.16 pm

Sitting suspended for a Division in the House.

4.26 pm

On resuming—

Mr. Webb : To resume where I left off in my response to the hon. Member for Stroud—as he is not here to answer me back, I will put this more strongly than I was about to—I simply observe that age discrimination legislation has not even been introduced yet, and when it is it will be very limited in scope. The relevance of that observation is that it relates to how long it takes us to start saying things that we really ought to have said a long time ago.

It would be churlish to say anything other than that the Minister's speech was analytical, calm and fairly non-partisan. However, I sat listening to her and thought, "What can I possibly disagree with in what I have just heard?" Sometimes, when I hear a speech with which I can barely disagree, I wonder—with no disrespect to the Minister—what the point is in a statement of the blindingly obvious. There is a reason for what I say and I will come back to it.
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When we make statements such as, "Early intervention is better than late", "If we can stop people getting stuck on benefits by intervening early, that must be better than just leaving them to rot", and "It's better to tackle the causes of incapacity at the workplace rather than let people become incapacitated and pick them up at the end", everyone in this Chamber just assents. It is so obviously true. The question is: why are we asking only now?

It is to praise the Minister—although it may not sound like it—to say that finally such issues are being discussed and something is starting to be done. But why was it not done seven years ago, or indeed 27 years ago? What has changed? I recall a conversation in the early 1990s with a senior official of what was then the Department of Social Security. I was an academic doing research into the growth in the number of people on invalidity benefit, as it was then called. The senior civil servant said to me, "Once they're on it, we just leave them to rot. We don't attempt to rehabilitate them; we just leave them." It is not surprising that the total rose remorselessly, year after year. He had that insight 10 or 12 years ago, yet here we are today, having almost just discovered that we should get to people early, intervene, pick them up when they have just lost their job, and look into workplace health and safety. We have almost just discovered that prevention is better than cure.

Therefore, I suppose that one question for the Minister would be: why has it taken us seven years to discover those self-evident truths? I guess that her argument will be that the new deal, and all of that, started with the unemployed, not the incapacitated. I think that the rhetoric is that one deals with unemployment first and gets it down to, say, 900,000—whether that is full employment I do not know, but down to a much more reasonable level anyway—and then one looks at the harder-to-help people. But is not that the wrong way round? Would not many of the unemployed people have got jobs anyway?

I know that there is a big debate about the new deal and so on. I think that work programmes have a part to play and that they need to be reformed rather than abolished. The Minister will know that practically none of the new deal money went to disabled people. It was massively focused on the unemployed and lone parents. What happened? Disabled incapacitated people got stuck on incapacity benefit, of course, because no one did anything for them.

Why did the Government do things that way round? Why was the vast bulk of the new deal not focused from day one on the incapacitated, who might otherwise get stuck and rot and never work again, rather than on the unemployed? Many of the unemployed, frankly, were fit, well and able. With perhaps limited support or as the economy grew, they might have got jobs anyway.

I will be interested in the Minister's comment on that strategy. Also, why are we only coming to where we are—rolling out the pathways pilot—seven or eight years down the track? Even the pathways pilot, we read, will only be rolled out to a third of the country in a few years' time.

There is a bit of a paradox here. I understand what the Minister says about a pilot—seeing what does and does not work—but she seemed to be saying two things that were inconsistent. She was saying that pathways to work
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is the best thing since sliced bread and that there were all these good results and so on. However, she was not sure whether pathways to work is good value for money, so the Government are not going to do a nationwide roll-out. Does that mean we think that it is fairly good value for money?

I do not think that holds. To say that pathways to work is being piloted and works in general, but we are not sure which bits work, so two thirds of the country will get nothing, is not credible. Surely, the pilots are showing that, in the round, these measures are beneficial. It seems self-evident that these early interventions and so forth will be, so why not have the nationwide roll-out? Is it capacity? Is that what is going on? If so, I think the House would accept that from the Minister, but that was not her reply. She spoke of a testing period, piloting and all the rest. That is not credible.

The focus of this debate is rehabilitation and healthy workplaces. One of my dilemmas is that a lot of this makes sense for big firms. Occupational health and welfare is, on average, better in big firms. They can probably afford to devote the resources and even have staff who can work full-time on such things, whereas, for the one-man band, the contractor, the self-employed and so forth, they are inevitably a much lower priority.

If we are concerned about occupational welfare, one of my key questions is how does the small firm—small and medium-sized enterprises and so forth—fit in? I think that the Minister's answer to that is a phone line—"Workplace Health Direct". That is great. I have no problem with a phone number to ring. It will be interesting to see in six months' time how many people have phoned, but it is better it is there than not, although I suspect that it is of marginal value.

Beyond that, the good guys are often the ones who ring the helplines. The people who really ought to be doing something—who are sloppy about occupational health, who let their workers work in poor conditions or get bad backs because of poor lighting or computers—do not ring the helplines until something has gone wrong. What is the Government's strategy for making sure that those smaller employers take the proactive approach that all hon. Members want to see?

Presumably, the Health and Safety Executive has to be part of the process—doing inspections, having a statutory role, going in—[Interruption.] The hon. Member for Stroud has returned. He can read my words of wisdom in the Official Report tomorrow. I think we pre-empted him.

On the health and safety front, the Government's record does not look so good. The Select Committee on Work and Pensions has made some strong criticisms of the Health and Safety Executive. It flagged up no fewer than five areas of concern, beginning with the total budget, which is down on 1997 in real terms. The performance of the Health and Safety Executive against its 2004 targets is best described as mediocre. There is a lack of progress on the commitments on legislative change that were made in the "Revitalising Health and Safety" document. There is what the Committee calls inadequate coverage of occupational health support, which is what we are talking about today, and
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inadequate strategies to reverse the threatened decline in consultation with workers by employers on health and safety issues.

That is a whole shopping list of areas where the Select Committee is worried about the performance of the Health and Safety Executive. It is not properly resourced to fulfil the very agenda that the Minister has come up with. What reassurance can the Minister offer that the Health and Safety Executive will be properly resourced to ensure that small firms, not just large ones, buy into the agenda that she mentioned?

It is all very well to say, as the Secretary of State did in a speech in December, that it makes good economic sense to take action such as talking to workers when they have gone off sick for a week rather than not phoning them for a month, so that they are far more likely to return soon and the companies save on sickness payments. It is another statement that is obviously true but, clearly, it frequently does not happen. How will the Government make that happen in the many workplaces where employers are short-sighted, think that they will never face that situation, or have not bought into the proactive agenda and hope that things do not go wrong?

In a sense, we have heard warm words but where is the beef? Where are the enforcement measures for employers who do not see that enlightened self-interest should take them down this track? Where are the teeth to ensure that that happens? If I work for an employer who is not terribly enlightened, what protection do I have if the enforcement body has its funding cut in real terms and there are many other concerns about its activities?

We would all agree that one critical aspect of rehabilitation is part-time work—a stepping stone and some re-engagement with the disciplines and routines of work but at a less demanding level than going straight back into full-time employment. My nagging doubt about the Government's incapacity benefit agenda is that sustained part-time work does not seem to fit. The hon. Member for Daventry (Mr. Boswell) used the analogy of the nuclear button being off or on. Part-time work on a sustained basis does not seem to fit, but it might be the answer.

I stress the phrase "sustained basis". I think of the example of local authority councillors only because I receive letters from around Britain about it. In the past, they could draw allowances for being councillors. Their health may not have been brilliant, but the one thing that they could do was be a councillor—they had the time and energy to do that. As their allowances were modest and they were not doing that many hours, the old therapeutic earnings rules came into play and they had a sustained existence through that combination.

My understanding is that the therapeutic earnings rules have gone and that the Government's position is that such therapeutic work cannot be done indefinitely. I am open to correction by the Minister, but I think that the current rules say that someone cannot continue to describe what they are doing as having therapeutic value. At some point, the crunch comes: the Government say that the person has proven that they can work week in, week out, albeit for not many hours, and that they should make their mind up—either they are incapacitated or not.
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There must be a set of people for whom sustained part-time work, which might be 10 hours a week or variable, is best. If the Government have an all-or-nothing approach, we do not end up with the best situation for those people. I refer back to the Chartered Society of Physiotherapy, which the hon. Member for Stroud mentioned. One concern in its briefing was:

In other words, if there is an over-obsession with work, by which I think the Government mean full-time work or something approaching it, there could be problems. Interestingly, the Department's own research bears out that personal advisers on incapacity benefit have the same concern. Let me quote a report entitled "Incapacity Benefit Reforms—early findings from qualitative research", in which incapacity benefit personal advisers were asked what concerned them about the new arrangements. Those advisers expressed

Although I am sure that the Secretary of State was right to say yesterday that the best thing for a bad back is not necessarily lying in bed all day, but doing a bit of work might be—there is a kernel of truth there—I am worried that such a statement of the blindingly obvious might be taken to extremes and that the Government's approach does not allow for the possibility that the answer might be different for different people. Sustained part-time employment, perhaps of variable hours, but typically a fairly small number of hours, might be the long-term answer.

My key point is that the national insurance system does not lend itself to shades of grey—it was never meant to. National insurance was about replacing lost earnings when people lost their job, whether to old age, sickness, or, in the case of widowhood, if their partner lost their job and was no longer an earner. The point of that was that, although the earnings had gone, people knew that they had a national insurance benefit, and when earnings came back—because work was basically synonymous with full-time work—they went off the national insurance benefit and into work. However, the world does not look like that anymore, which is why I am worried that the reformed incapacity benefit that the Government have proposed still does not allow for that.

The basic £50 a week, or whatever it will be, is still an all-or-nothing payment and could not be gradated so that, for example, someone could do eight hours a week at the minimum wage and get £35 or £40, and then perhaps have some partial capacity benefit on top of that, whether £20 or whatever. That would provide a package allowing them to do some work, perhaps over a long period or indefinitely, and draw less, but not nothing, from the taxpayer.

I will not keep repeating that point, but it is the kernel of one of my concerns about the present system and the Government's reforms, which are still modelled around national insurance—and national insurance is still all or nothing.

Jane Kennedy : I am listening carefully to what the hon. Gentleman has to say and I am interested in his probing into our proposals. We have had some brief
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discussion about the Conservative party's proposals, but will he take this opportunity to let us in on what his party's ideas on this matter might be? There has been a lot of criticism and comment from him on our strategy so far, but the Liberal Democrats have to do slightly better than saying, "We are going to replace it all with something that works better", which is broadly what he has said.

Mr. Webb : That is an unfortunate intervention, because I have, in a sense, already made two specific suggestions, but perhaps the Minister was not listening at the time. I pointed out that the balance of the new deal was massively towards the unemployed, not the disabled. That balance is wrong and needs to be redirected far more towards disabled people, which is far more cost effective, because more money is saved for each person who is moved off incapacity benefit, for example, than for someone who is moved off jobseeker's allowance. Within the total budget, the balance is wrong.

Jane Kennedy : Does it follow, then, that in the event of the hon. Gentleman's party being elected to Government, it would abandon the new deals and replace them with a revamped new deal for disabled people, which is broadly like the Conservatives' proposals?

Mr. Webb : No, it does not remotely mean that. The Conservatives propose scrapping the new deals, whereas we are talking about the same total budget with a different prioritisation. In other words, there will still be the new deal programmes as budgeted by the Government in the forthcoming spending profile. We will match that spending, which is already in the Government's spending plans, but we will reprioritise. We are talking not about scrapping the new deal for the unemployed and spending it all on the disabled but rebalancing.

I think that I am right in saying that disabled people have had less than 5 per cent. of the whole new deal since Labour came to power, but I am open to challenge on that. I hope that the Minister will say why that is so. Why have disabled people been so far at the back of the queue for new deal money, when they were the people who the tailored, individualised support could have done far more to help?

The Minister asked what we would do. I think that she jumped up because I used the phrase "partial capacity benefit". We use that phrase because it summarises another strand of our approach, which is as I just described—not the national insurance benefit, which is all or nothing. That approach recognises that people have partial capacity—capacity to do a certain number of hours, perhaps combined with a lower rate of benefit, but more flexibly than the present all-or-nothing system. That is a second concrete positive suggestion for how the system might work.

The importance of the part-time work issue was highlighted by the Secretary of State in a speech that he made to the Commercial Occupational Health
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Providers Association conference on 1 December— I have to say that I missed it. Paragraph 34 of his speech stated that good practice can involve

I agree. The gradual return to work and the period of part-time employment could be a good thing. My point is that the system does not accommodate that fantastically well. The things that the Secretary of State applauds do not fit very well with the all-or-nothing system, particularly if they are prolonged. I am aware, and I welcome the fact, that some of the pilots and the individual stuff allows greater flexibility. Even in those cases, my understanding is that they are time limited; at some point, there is not exactly the "get on your bike" message, but something akin to it. I am not sure that that will be right for everybody.

I want to touch on a point that I raised in an intervention. The context of this debate is the apparently stubbornly high number of people on incapacity benefit. The 2.7 million figure includes, as the House will know, about 300,000 people on severe disablement allowance. If we ignore them—not because they are not important, but because they are a different category of people—and focus on incapacity benefit, the 2.4 million who are currently on it is pretty much the same number as 10 years ago. It has not fluctuated much in the past 10 years. It tripled under the Conservatives, but since the mid-1990s the number has been flat. What has changed is its composition.

Mr. Boswell : Before the hon. Gentleman leaves that point, and in a sense reverting to a comment made earlier by the Minister, does he not agree that within that relative stability of the past 10 years, even if there has been a reduction in claimant numbers, as the Minister claimed, that has been matched by an expansion of the period in which claimants are claiming? There have been fewer coming on to the benefit, but those who are on it are staying on it longer.

Mr. Webb : I think that, if average durations were rising, other things being equal, the stock would tend to rise. I could not comment on whether the fall in the inflow has offset the rise in the average durations.

The point that the Minister made is right: a large number of people are on incapacity benefit who have been on it for a long time. I do not think that any of us would dispute that. I will use the 2.4 million figure and leave the severe disablement allowance people out of the picture. The composition has changed dramatically. In the mid-1990s, only just over 500,000 were the credits-only people—the people who do not actually get the cash. Now the figure is nearly 1 million, out of the same grand total. That means that the number of people who get cash from incapacity benefit is dropping quite dramatically.

The Minister seeks reassurance on that point, which is interesting. I do not think that the Government have got a clue what is going on, although that is probably rather rude. About two years ago, when I last saw the figures, I asked another Minister from the same
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Department what was going on with the rise in the numbers of credits-only people. He said, "I haven't a clue". Yet they are now one third of all the incapacity benefit recipients.

I tabled a parliamentary question earlier in the week asking what research the Department has undertaken about those people and whether it will undertake some, because something rather worrying is going on when nearly 1 million people pass the incapacity test, prove they are incapable of work and do not get any money. That is partly because the national insurance rules have been tightened, but mainly because they are not coming from the workplace.

Bizarrely, we are having a debate this afternoon about stopping people flowing from the workplace on to incapacity benefit, which is entirely legitimate—I would not want to be quoted as saying that it is a sideshow—but it is not the biggest problem that we have. That is people coming from spells of non-employment, broadly defined, on to incapacity benefit.

I have not heard anything from the Minister so far. One cannot expect her to know the minutiae of these things—I certainly do not—but at the start of the debate she was under the impression that those people about whom I am talking did not even qualify for the pathways to work assistance. I do not get the sense that the Government have a grand strategy for the fastest-growing group, and that worries me. It would be great if we were to have all the things we have been talking about—the workplaces where people are prevented from falling sick, or where when they fall sick there is quick intervention—and more power to the Government's elbow on that. However, what will happen with the fast-growing group that will continue to grow? I ask that, because I cannot see that a lot is being done for it.

In a sense, that is the broad outline of my concern. There is almost nothing that I disagree with in what the Minister said. One wonders why it took seven years—or 27 years in some regards—to make a start on this agenda. However, having said that, I cannot point to a speech I made 27 years ago where I demanded it, so we all have the benefit of hindsight, and better late than never is my response to what the Government are now doing. However, there are two big gaps in what they are doing. First, there is a failure to recognise that part-time work for a long period might be the best answer. I do not think that even the reformed system addresses that issue. Secondly, if we are worried about people getting stuck on IB—or incapacity more broadly defined—we should address the fact that there is a rapidly growing group about which we know precious little, and about which we appear to be doing even less.

4.51 pm

Jane Kennedy : With the leave of the House, I will reply briefly to this interesting debate. My hon. Friend the Member for Stroud (Mr. Drew) talked about the stress teachers face in the classroom and how that affects the likelihood of their retiring from work early. There is a little known fact that hon. Members may be interested in; the esteemed mother-in-law of the hon. Member
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for Daventry (Mr. Boswell) was partially responsible for the education of my hon. Friend the Member for Ogmore (Huw Irranca-Davies). [Interruption.] Indeed, his political education. I am sure she could give testimony to the stress related to that task.

Mr. Boswell : For the avoidance of doubt, I should say that I was trying to tell the Minister that my mother-in-law was in no sense responsible for the political education of the hon. Member for Ogmore (Huw Irranca-Davies). I ought to put that on the record.

Jane Kennedy : My hon. Friend the Member for Stroud made a very thoughtful contribution. He rightly pushed back the boundaries of the debate by considering issues around the rehabilitation of people with particularly chronic illness. He also described the experience of his local hospital, where he believed that the health service was withdrawing from important services. I will ask for further details on that. However, I want to respond now to an important point that my hon. Friend made. It relates to the habit of our comrades in our constituency parties of raising particular issues whenever they get the opportunity; there was a lady who raised a concern about not being allowed to work longer. My hon. Friend is correct that we have not yet implemented that measure, but we will do so. The right to request to continue to work beyond retirement age will come into force in about October 2006, so if she had been 18 months younger she might well have been in a position to argue that her employer could sustain her in employment.

I am a little clearer about the comments of the hon. Member for Northavon (Mr. Webb), and I will read with interest his comments in Hansard on what he would do in our place. His last point was about the flow on to IB—where the increasing numbers are coming from, and the fact that they are from the group he referred to. He was right about that; we have many different categories of client, and I apologise for my earlier mistake. Let me explain my immediate response to his point. What we are experiencing with our personal advisers should be seen in the context that that this new approach to dealing with benefit customers is still being rolled out; we are still only about just over half of the way through the roll-out of Jobcentre Plus. Therefore, the bringing together of the two services is not yet in full effect in integrated offices throughout the UK. We are only beginning to see some of the effects of this work.

What happens now is completely different to what used to happen in the past. When people present themselves to Jobcentre Plus in the first instance, whether to claim jobseeker's allowance or any other benefit, they undergo a financial assessment and their circumstances are assessed by Jobcentre Plus staff. That is a new departure. Previously, the old Employment Service and the Benefits Agency would simply have responded to an application made by an individual and no check would have been made of their circumstances to assess whether other benefits that they might get, but for which they had not initially applied were appropriate.

We are looking at the circumstances that the hon. Member for Northavon describes, but my sense of what is happening is that as people come in for advice through the jobcentres and Jobcentre Plus, they are being
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directed, in some cases, towards incapacity benefit as something to which they are entitled by virtue of their circumstances, except that they do not get IB, but the related benefit, even though they have not been in work. There are other factors in play that we are still studying, but we are interested in this matter—we are not unaware and uninterested. There are other trends in the benefits field that are of interest and which we are also studying.

The hon. Member for Northavon made a great play about saying, "If it is all so great, why didn't they start doing it seven years ago?" I have already said that the development of Jobcentre Plus continues and by this time next year we should be approaching the end of its roll-out. It has required a huge investment of resources, not just in the physical infrastructure of the offices but in the support, management and reorganisation of staff. That has been a major task and has taken up a lot of the energy and resources that were available.

The hon. Gentleman is right. When we came into office, our priority was unemployment and dealing with the legacy of the Conservative years, from which we inherited crippling levels of unemployment. We focused rightly on how to enable people to move back into work who could, perhaps, easily be described as the easiest to help. Although the new deal for disabled people was developed relatively quickly, it still helps only about 3 per cent. of the population who are in receipt of these benefits, primarily because it is a voluntary scheme. We have to go through a huge process of re-education with a lot of people who have been told by their doctors that they are incapable of working.

The hon. Gentleman talked about people passing the incapacity test so that they are deemed incapable of work, yet he and I would probably agree that there is a significant proportion of people in receipt of such benefits who could work if they were in receipt of the right support and help. That is why the strategy in which we are engaged and which we have published is the right one.

It is true that we had the principles in place from an early stage. Early intervention was the right principle. However, for the reason that I have just described—broadly, capacity is one reason—we never tested the model that we are now testing in pathways; it has never been done before in a social security context. For the first time, pathways is giving us a unique model that is proving successful in its early days and will provide us with the framework on which we will build further. However, we need to be careful.

My quick response to the intervention by the hon. Member for Daventry on my earlier speech, was that we still need to be careful, evaluate what we are doing and ensure that we get the most effective intervention for the resources that we are investing.

The hon. Member for Northavon questioned me about the workplace health direct pilot. He said that he was not being disparaging. However, the service is not merely a telephone helpline, although it will provide important advice. He might want to consider the experience in Scotland, where that service has been piloted for two years. That pilot is coupled with pilots
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running in regions, which will test what occupational health support people can be encouraged to develop in the current environment, but we are trying out different ways in different regions and the Health and Safety Executive is taking it forward.

The Scottish example is small in scope, but we will learn valuable lessons from it. Clearly, it must still be a partnership-based approach; it is not a whistleblower's telephone line to report employers for bad practice, but a matter of getting advice about a set of circumstances that can be raised with the employer in a sensible, constructive way that encourages them to behave responsibly and to deal with the risk that is identified.

On the matter of sustained part-time work being best for some people, what we intend as we develop the new strategy is that everyone on IB will be able to do part-time work for periods of 52 weeks as it stands, but people on IB with the greatest health-related barriers to working full-time will, as a result of the changes that were announced in the pre-Budget report, be able to work part-time permanently—the change to the linking rules to which the hon. Gentleman referred earlier. People with advanced progressive conditions or severe mental illness will be acknowledged to be in the categories that he described. I hope that that has clarified the point for the hon. Gentleman.

The hon. Member for Daventry, in a very interesting contribution, described our progress as glacially slow. I think he and I share some frustration on that score, but we must consider how far we have come since 1997. It is important to remember that new claims are down by a third and numbers in the case load have peaked; it is a small fall, but the latest figures suggest a 9,000 fall in the overall numbers. If it is sustained, we will be able to say that we have established a trend. I am looking forward to the next figures with great interest.

The hon. Member for Daventry might also be interested in considering the international situation. In the US, the experience is of a rapidly increasing case load of those who are economically inactive for health reasons. New Zealand, too, has a similar experience. These are complex problems, which have been created over a generation; they will not be resolved easily and we should take pride in the fact that the UK Government are seen as a world leader in this respect. We are in the forefront of Governments who are trying to tackle the problem and we have developed a highly imaginative and innovative way of dealing with it. The hon. Gentleman asked how we would draw the line between the rehabilitation and support allowance and the disability and sickness allowance. Hon. Members will be reassured when I say that much detailed work and consultation will be undertaken on the issue.

In a statement yesterday, the Chairman of the Select Committee requested that the matter be given pre-legislative scrutiny, and my right hon. Friend the Secretary of State will consider that request carefully. However, in general terms, the rehabilitation and support allowance will be for people with less severe impairments that can be managed, with the right support, so that they are not a major long-term obstacle
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to getting back to work. For example, people with conditions such as lower back and neck pain, angina and depression are likely to receive the benefit.

The disability and sickness allowance will focus more on those with the most severe impairments, where the health problem or disability will form a very significant obstacle for some time. The hon. Gentleman and I can think of the kinds of cases that that will include. We know of many people who still work with severe impairments, so we are not saying that they will not be entitled to work.

Mr. Boswell : I seek the Minister's elucidation on two matters. First, I take it that the distinction between the two allowances will arise from the personal capacity assessment, so it will itself have to be altered to differentiate between them. Secondly—this is a matter of principle—if an action plan is drawn up following a personal capacity assessment and the person is compliant in trying to get back to work, it will send an extremely bad signal if the benefit is scaled down for failure to complete the action plan as a result of circumstances outside the claimant's control—for example, a failure to receive treatment in time.

Jane Kennedy : The hon. Gentleman's second point is entirely valid. The answer to his first point is yes: a personal capacity assessment will still be made. In a sense, the people with whom we will be working will drive this agenda. There are people with severe health impairments who will none the less say, "I still believe that I can work". It is important to say that we are not writing anybody off.

The hon. Gentleman asked about the vocational rehabilitation framework. I shall try briefly to summarise what that is about. In October last year, I launched the framework document, which stresses that the current inconclusive evidence base on vocational rehabilitation should not preclude considering how we can move forward on this issue. The document helps stakeholders who are considering introducing vocational rehabilitation, highlights the key messages in research and allows stakeholders to influence current practice and encourage the development of good practice.

I am sure that hon. Members will agree that there are a large number of Government strategies and initiatives focused on people not in employment. The work to help people with health conditions or impairments retain employment has started only recently. Do not ask me again why it did not start before as it is such a good idea. Clearly, that work is just beginning. Momentum needs to be generated. The framework suggests that the initial efforts flowing from the initiatives should be focused on helping people in employment remain in employment.

We can supply the hon. Member for Daventry with a copy of the framework, which might help him. He talked about the confusion that might arise in the minds of employers about the range of rehabilitation services available; confusion about, for example, competition between the Health and Safety Executive and the Department of Health. He is right. The various teams and agencies involved in providing those services are already being co-ordinated. There is a great deal of interest in the issue across Government because we see
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benefits flowing, not just for the Exchequer but for the general health of the nation. There will be benefits for employers, too.

I have already said that the linking rules will remain an integral element of the new scheme. If I may say so, I am still not much clearer about the Conservatives'
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plans on their "opportunity first" programme. We shall continue this debate on other occasions, and I am sure that public interest will remain focused on this issue.

Question put and agreed to.

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