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It is of real concern that the evaluation of the dummy runs seems to be the main evidence that will inform the draft regulations, which we were told would be made available to the other place when it starts
consideration of the Bill. In that context, it is important to place on record the concerns put to me by outside groups about the way in which the dummy runs have been carried out. As I understand it, fewer than 100 claimants were tested, which is a very selective and not necessarily representative sample. It is therefore hard to make like-for-like comparisons. Importantly, the process was not followed right through to the appeals stage. All Members will know from their constituency casework that the high number of appeals against personal capability assessments for incapacity benefit was one of the main reasons for the revision of the test. Some 50 per cent. of appeals against decisions on the personal capability assessment are successful. Unless one follows the new assessment process through to the appeals stage, to try to understand whether appeals against decisions made under it are likely to be successful, it will be hard to judge whether the new assessment process is better or worse than the old one.
Mr. John Redwood (Wokingham) (Con): Is not the period of transition the most dangerous time for the vulnerable people about whom we are talking? Will we not need some interim review of the new assessment process long before a year or moreas the new clause suggestsis up? If this is such a comprehensive reform, how will we deal with it quickly if it starts to go wrong?
Danny Alexander: The right hon. Gentleman makes an important point. Two things need to happen. First, a much more comprehensive assessment of the revised PCA is needed before draft regulations to put it into practice are brought forward. That needs to involve independent outside organisations such as disability lobby groups and others that have had an advisory role.
John Bercow (Buckingham) (Con): The observation made by my right hon. Friend the Member for Wokingham (Mr. Redwood) also highlights the importance of widespread and continuing consultation. Will the order-making power of subsection (2)(b) of the proposed new clause be subject to the negative procedure of the House or to its affirmative counterpart?
Danny Alexander: I am grateful for that intervention [Interruption.] I think that the answer to the hon. Gentleman is yes, as the Minister has pointed out from a sedentary position. The import of that is that the Office for Disability Issues, which has been established in the Cabinet Office to ensure that the interests of disabled people
The Parliamentary Under-Secretary of State for Work and Pensions (Mrs. Anne McGuire): For the record, the Office for Disability Issues is in the Department for Work and Pensions, not the Cabinet Office.
Danny Alexander: I am grateful for the intervention, but in that case it is possible that the Office for Disability Issues is getting too close to the DWP. Nevertheless, it has a role in ensuring that disability issues are dealt with in a joined-up way throughout Government, which is why I suggest that it should be required to provide an annual report.
Let me take up the second point made by the right hon. Member for Wokingham (Mr. Redwood). We shall need to get the assessment right in the first place, but we shall then need an ongoing process of reassessment, re-evaluation and reporting to ensure that it continues to work. We must make certain that the vulnerable people who, in many cases, are subjected to assessments continue to be discussed in the House, and are not left with what may turn out to be a thoroughly inadequate process.
Mr. Tim Boswell (Daventry) (Con): The hon. Gentleman will not be surprised to learn that I agree very much with what he is saying. Is it not also important for the assessment to cover any anomalies or disparities in either the regional or the sectoral treatment of persons subjected to the assessment, given the possibility that different regions or groups of examining medical officers may take different views and may also have blind spots on particular kinds of disability?
Danny Alexander: The hon. Gentleman makes an important point. Regional disparities can arise in the wider debate about incapacity benefit for a number of reasons, and indeed we see regional concentrations of claimants in the statistics. I am sure that Members in all parts of the House will have observed variations even between individual doctors. I suppose that that is largely a management issue for the company that administers the assessment, but incorporating it in an annual report to Parliament would be a vital way of enabling us all to keep an eye on it.
Mr. Mike Weir (Angus) (SNP): Is the hon. Gentleman aware of a report from Citizens Advice which draws attention to the difficulties already being encountered? One case involves a woman with myalgic encephalomyelitis. She was given only seven points at a medical examination, but the doctor himself advised her to appeal, and on appeal she was given 33 points. The difficulty appeared to lie in the computer systems inability to take account of variations from the standard. Should not the review look into that so that we can ensure that the computer program reflects the wide range of disabilities that exist?
Danny Alexander: The hon. Gentleman rightly refers to problems that have been identified in the existing system. In fairness to the DWP, I should say that its work, particularly in relation to some of those mental health and neurological issues, has made progress in terms of how fine-grained the assessment is capable of being. Nevertheless, while it is all very well for us to look at the words in the draft regulationsthe 45 descriptors and so onunless there has been proper and rigorous testing it will be impossible to know whether the new arrangement will work better or less well in practice than the current system, and that is the burden of the new clause.
Let me return briefly to the question of the dummy runs that have been carried out so far. It would be useful if the Minister could give further details of the outcomes. I understand that while the new assessment would have given more claimants with mental health
problems entitlement to benefit, on the basis of the dummy runs it would also have meant that many of those currently entitled to benefit owing to physical disabilities would no longer have been entitled to it.
Mr. David Ruffley (Bury St. Edmunds) (Con): What does the hon. Gentleman think of the fact that the rise in the number of people who will be able to claim after passing the mental health descriptor is matched by a commensurate rise in the number who do not pass because they have not satisfied the physical descriptor test? Does he think it a rather odd coincidence?
Danny Alexander: The way in which the Government have described their intentions in relation to the revision of the personal capability assessment does not suggest that they wish an increase in the number claims for one reason to be matched by an equal fall in claims for another reason. It may well be a coincidence, and it may well mean that further work must be done to ensure that the test covers all possible reasons for claims. That is another reason why much more detailed scrutiny is needed, along with independent evaluationnot just dummy runs conducted by the company that is contracted to carry out the test, which strikes me as thoroughly inadequate. If we proceed on that basis, it will not lead to the outcome that I hope that all Members wish for. We need a much more detailed evaluation of the assessment, plus ongoing independent evaluation. If the new clause is agreed to by the Governmentwhich is, perhaps, unlikelyor supported by Members, that will also allow there to be much more detail of how LIMA, the computer program behind the assessment, works in practice. That will be made publicly available, which will be of particular interest to lobby groups that are expert in dealing with certain conditions or impairments.
I hope that Members will support the new clause, and if the Minister is unable to provide the reassurances that we think are necessary on what are important points, we will seek to press it to a Division.
Mr. Jeremy Hunt (South-West Surrey) (Con): I support new clause 3. Some of my arguments will echo those made by the hon. Member for Inverness, Nairn, Badenoch and Strathspey (Danny Alexander), but I make no apology for bringing important issues to Members attention once again.
The new clause is not particularly onerous. It will not cost the taxpayer any more, but it goes to the heart of the Governments commitment to make sure that the new employment and support allowance succeeds where incapacity benefit has failed. The solution to any problem must start simply with a correct diagnosis of that problem. For incapacity benefit and the new employment and support allowance, the crucial gateway is the personal capability assessment. There are, however, problems with that gateway, and they have produced the major issues in respect of incapacity benefit.
The new clause simply requires the Government to publish an annual report on how that gateway is working, and to do so following consultation with key organisations such as the new Commission for Equality and Human Rights, which it is hoped will be as able an
advocate of the concerns of disabled people as its predecessor body, the Disability Rights Commission.
Why is this subject so important? Mistakes in how the gateway works cause enormous distress and cost the taxpayer huge sums of money. In 2005, 50 per cent. of appeals against incapacity benefit decisions were successful; that is an enormously high rate, and should be a real concern to the Government.
Two examples given by the Citizens Advice illustrate that point. In one, a client with a severe skin condition lost incapacity benefit following a personal capability assessment that which awarded him five points, but at his appeal five months later he qualified for 16 points, although he then immediately received notice of another PCA medical examination. In another example, a woman with MEmyalgic encephalomyelitiswas given only seven points at a medical examination, but the doctor who carried it out advised her to appeal, saying that the computer would not allow him to award more; the client received 33 points at appeal. To borrow words that some Members might be familiar with from Christmas viewing of Little Britain episodes, the computer says no and people lose their benefit only to be re-awarded it later at great cost to the taxpayer as well as great personal distress.
Adam Afriyie (Windsor) (Con): I am pleased that my hon. Friend raises the matter of assessments and what might be termed the 50 per cent. failure rate on incapacity benefit. Does he share my greatest concern that those with mental health challengesin particular depression and bipolar depressionwho are already undergoing enormous amounts of stress that is partially debilitating will be caused even greater stress if the facts and evidence do not come out, and if personal capability assessments are not reviewed on a regular basis to ensure that they are better?
Mr. Hunt: I am grateful to my hon. Friend for those comments, and with his usual foresight he makes some of the points that I was going to make. He is correct that getting the gateway right is most important in dealing with people with mental health challengesa subject that he takes great interest in and on which he has campaigned a great dealand with those with learning disabilities.
A second reason why it is so important to get the gateway right is that there can be no confidence in a new benefit if there is no confidence in the assessment process through which the benefit is awarded. That confidence is sorely lacking in respect of incapacity benefit at the moment. Why? First, it is because limited capability for work is defined as an essentially medical process. Many people would like to broaden it to include not just the responsibilities of disabled people to seek work when they are capable, but the responsibilities of society as a whole, so that it can play its part in including those people in the labour market.
The elimination of prejudiceseen, for example, in the fact that 38 per cent. of employers are unwilling to employ a disabled person, which rises to 63 per cent. in respect of people with a history of mental illnessis a critical factor, as such prejudice limits peoples capability to work. It has to be said that it is difficult to work out how it could be measured in an assessment
process, but the new clause would at least allow that debate and might allow the assessment process to adapt to meet the challenges posed not by a persons impairment, but by the obstacles thrown in his or her path by a society still coming to terms with what it means to include disabled people in the mainstream.
Another reason for concern about the way in which the personal capability assessment has operated historically is its ability to deal with fluctuating conditions such as bipolar disorder, which my hon. Friend the Member for Windsor (Adam Afriyie) mentioned. In a seminar on benefit reform that I organised last year, one of the participants who had bipolar disorder explained what happened when she went for her assessment. It is a fluctuating condition and she felt fine on the day that she had her PCA, but because she was worried that her assessor would not understand what a fluctuating condition was, she felt obliged, in her words, to ham up her condition to ensure that she secured the assessment result that she needed.
A widespread concern about the current PCA process is that it does not adequately recognise not only fluctuating conditions but hidden disabilities such as autism and other learning disabilities. The National Autistic Society says that 40 per cent. of GPs do not have enough information to make informed decisions relating to autism. The result is that people with autism can often be mistaken for being belligerent and unco-operative. That is a real concern. Clause 8(4) states:
Regulations under subsection (1) may include provision... for a person to be treated as not having limited capability for work if he fails without good cause... to provide information or evidence in the manner in which he is required under such regulations to provide it.
Mr. Boswell: Does my hon. Friend agree that that also applies to people with Tourettes syndrome, who might well be unable to conduct what we might call a civil conversation? Indeed, some have already found themselves victims, if I may put it that way, of antisocial behaviour orders because of the nature of their medical condition.
Mr. Hunt: Absolutely. There is a whole range of conditions of which Tourettes is a very good example. My hon. Friend is right to draw the Houses attention to those problems. I would also make the point that the range of conditionsincorporating hidden disabilities, learning disabilities, mental health problems and so forthis such as to require a considerable amount of training in order that any assessor or doctor may understand those problems and make an adequate assessment.
the majority of people who carry out PCAs will be locums. Most will be GPs who have done a days work and will do PCAs in addition.
certainly do not have much in-depth knowledge of mental health problems in the experience of our advisors who work with people with mental health problems.
spoke recently to one of our welfare rights advisors. She attended... 50 PCAs with various clients and in only one case did she find the person to have any understanding of what the issues were, to treat
with respect, and to conduct the assessment at a pace that could give the person the opportunity to discuss as much as was needed.
Minds view is that, as a minimum, assessing GPs should have NVQ level 3 in mental health training. Citizens Advice has particular concerns about the ability of Jobcentre Plus personal advisers to identify appropriately and accurately the support needs of people with fluctuating and unpredictable conditions, or those whose conditions are likely to get progressively better or worse over time. Customers with mental health problems were seen as particularly challenging and even more experienced advisers did not feel confident working with them.
As my hon. Friend the Member for Daventry (Mr. Boswell) said to me yesterday, this is not just an academic exercise. Some 40 per cent. of people on incapacity benefit have mental health issues as their primary condition, and if people who have them as a secondary condition are included, the number rises to nearly two thirds. So understanding mental health issues is key to effective reforms of the assessment process.
A further concern is the relationship between the medical assessor and the decision maker. In Committee, the Minister said that the decision maker is not there to second guess Atos Origin but to check that procedures have been followed.
John Bercow: Before my hon. Friend develops that argument, I wish to press the rewind button and take him back to the important point that he was making about the requirement on individuals to provide information in the manner required by the terms of the Bill. He could have been referringalthough I do not know whether he wasto clause 8(4)(a)(ii). If the Government are to do the right thing, and possibly avoid contravening disability discrimination legislation, it is essential that they should preserve maximum flexibility for the client as to the manner in which the information has to be provided. Why be excessively prescriptive unless it is essential to the evaluation process?
Mr. Hunt: My hon. Friend makes an important point. That variety of means by which people may supply the information that they are required to supply is important, because the range of disabilities is so vast. The purpose of the new clause is to ensure that there is a process in place whereby it is possible to adapt and improve assessment as time goes on as a result of being able to learn from things that we are not able to predict.
Another worry is to do with the timings of different stages of the assessment process. A claimant needs to go first through an assessment of limited capability for
work, then an assessment of limited capability for work-related activity, and then potentially a work-focused health-related assessment. Those may sound complicated but to a claimant they are vital, because failure to co-operate at any stage could mean that the benefit is not awarded or that sanctions are applied, even if a claimant wishes to appeal against an earlier decision.
The Government, to their credit, recognise the problems with the existing PCA. On the question of broadening the understanding of mental health conditions and hidden disabilities, the Secretary of State said to the Work and Pensions Committee in the spring that his understanding was that the Government should
involve the skills and expertise of a wider relevant range of healthcare professionals.
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