Welfare Reform Bill

Memorandum submitted by the British Heart Foundation (WR 62)

1. The British Heart Foundation (BHF) is the UK’s leading heart charity. We are fighting against heart and circulatory disease – which is the UK’s biggest killer and claims around 180,000 lives each year [1] . Our vision is of a world where no-one dies prematurely of heart disease.

2. The BHF welcomes the ambition to simplify and streamline the welfare support system. In this submission we identify a number of risks and concerns that we believe must be addressed to ensure that every heart patient receives the financial support they need.

3. The BHF is also member of the Disability Benefits Consortium (DBC) [2] , a national coalition of over 40 charities and other organisations committed to working towards a fair benefits system.

Heart patients and the welfare system

4. While there has been great progress in reducing death rates, the number of people living with heart disease is set to increase as the population ages, as risk factors increase, and as more people survive premature cardiac events. There are currently around 2.7 million people in the UK living with coronary heart disease (CHD), and nearly 810,000 with heart failure [3] .

5. The symptoms of people with heart conditions vary significantly depending on their particular condition, from person to person, and from day to day, and so too therefore does the impact on their working life and financial circumstances. For example, after developing a heart condition some people are able to continue leading a full and active life, others may be off work for a significant amount of time or may need to change to a less demanding or part-time job (and subsequently sometimes a lower paid job) and some will not be able to work again.

6. The impact on the working life of carers and family members will also vary. For example, congenital heart disease (affecting 1 in every 145 babies) [4] can usually be repaired with surgery, but children with some types of complex congenital heart disease often require full-time care from a parent or carer.

7. Some heart patients also require mobility aids, adaptations to their home, and a complex long-term medication regime, all of which may have associated costs.

8. Many heart patients and carers therefore face significant financial challenges as a result of the condition, and depend on financial support from the welfare system.

9. Furthermore, evidence shows that the risk factors for heart disease are more prevalent [5] , and death rates from heart disease are higher, among people from lower socio-economic groups [6] . These groups are less likely to have the financial reserves to cope with a sudden loss or reduction in earnings. In addition, the risk factors for heart disease increase the likelihood of developing other conditions (such as COPD).

The principles of reform

10. We firmly believe that any reform to the welfare system must adhere to the following principles:

· The reforms must promote fairness, and must help to tackle, rather than widen health inequalities

· The reforms must provide people with the benefits they need, when they need them

· Eligibility criteria must be transparent and consistent

· Assessment must be straightforward and effective at identifying those in need

· People must be made aware of all benefits to which they may be entitled

· Robust plans must be put in place to ensure a smooth transition to the new system.

Risks and concerns

Support for those with moderate needs

11. We are concerned that moving from a two-tier rate for the new Personal Independence Payment (PIP) (replacing the Disability Living Allowance (DLA)) care component, from the current three-tier system, may result in people with moderate, yet not insignificant needs, losing out. The most recent available figures show that nearly 30,000 people with heart disease receive the lower rate of the care component of the Disability Living Allowance [7] . We are also very concerned about the impact of predicted cuts of 20 per cent in expenditure.

12. Leaving people with moderate needs without support may result in a decline in living conditions and quality of life, leading ultimately to a greater burden on the welfare system as well as the NHS. We are seeking confirmation that those people who are currently eligible for the lowest level of DLA will still be eligible for the PIP.

Fair assessment

13. The PIP assessment system must be straightforward and must not place additional stress and strain on people who are vulnerable. To best reflect individual needs, the assessment must take into account the variable and unpredictable nature of some conditions, including heart failure and unstable angina. A person with an unstable condition may be capable of doing moderate physical activity or performing a manual task one day, and then unable to perform the same task the following day.

Swift access for those in urgent need

14. The BHF is concerned about the extension of the qualifying period for the PIP from three months to six months. Many people develop a sudden and unexpected onset of a heart condition or a worsening in their condition - people with heart failure, for example, often experience rapid changes in condition, and every year in the UK it is estimated that 124,000 people suffer from a heart attack [8] . In addition, if the extension is applied to children, this could result in delays in financial support for families with babies born with congenital heart conditions. Patients and families who are in need of urgent financial support because of a health condition (based on clinical judgment), must not be subject to the six month qualifying period and must have swift access to the financial support on which they depend.

Raising awareness about the support available

15. The BHF is concerned that many people living with heart disease are unaware of, or find it difficult to access, the benefits for which they may be eligible. While it is hoped that simplifying the system will go some way to addressing this, effective and accessible communications are also needed to proactively raise awareness of the benefits that are available and to ensure easy and swift access for those in need.

Continuing access to passported benefits, including free prescriptions for people in England

16. It is unclear whether those people who currently receive the DLA (and in future the PIP) will continue to have automatic entitlements to passported in-kind benefits, including, for people in England, free prescriptions (in Wales, Northern Ireland and Scotland prescriptions are free for everyone).

17. The BHF is a member of the Prescription Charges Coalition, a coalition of 24 charities, calling on the Westminster Government to abolish prescription charges for all people with long-term conditions in England. The BHF is calling for confirmation that welfare reform will not result in a worsening of the current system by removing free prescriptions from those who are not currently required to pay.

Support for carers

18. The reform of welfare system will have an impact not just on people with heart conditions, but also their carers, who may have to reduce or give up work. We urge the Government to give urgent and careful consideration to the impact on carers and families of changes to the DLA.

May 2011

[1] www.heartstats.org

[2] http://www.disabilityalliance.org

[3] www.heartstats.org

[4] www.heartstats.org

[5] For example, in England in 2006, the prevalence of high blood pressure was a third higher in women from the lowest income quintile than those in the highest income quintile (www.heartstats.org)

[6] F or example, in 2001-03, the death rate among female workers with routine jobs was five times higher than those with managerial or professional jobs (www.heartstats.org)

[7] See:

[8] www.heartstats.org