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Individuals applying for employment and support allowance will be required, as we have heard, to undergo both a PCA and a work-focused, health-related assessment at the same time or sequentially, with a doctor who is not necessarily qualified to assess work capabilities
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Combining the two assessments risks confusing both the assessor and the claimants, and could sow mistrust between claimants and their personal advisers. Health professionals trained to determine a person’s ability to work or undertake work-related activity are not necessarily best placed to assess a person’s vocational rehabilitation training needs. We need to learn more about how people will be trained to administer these two related assessments; it is by no means clear.
The Bill goes further than the Green Paper in extending the use of sanctions. They have been extended to cover attending a work-focused, health-related assessment and undertaking work-related activity. There is no evidence that sanctions are necessary to achieve the welfare reform objectives, and it is not clear why the use of sanctions has been extended and how they will work in practice. For people with a serious mental illness, further sanctions would add a fear factor in the system which will be counterproductive. I do not believe that it is desirable for sanctions to be extended to cover health-related assessment and work-related activity, nor am I confidant that the skills and knowledge of DWP staff can ensure that sanctions are fairly applied. However rarely they may be applied in practice, in reality everyone will know about them and have an instinctive fear of them.
People with a mental illness usually want to work, and it is a tragedy that three-quarters of all adults with schizophrenia in this country have no employment; indeed, many employers say that they would not employ them under any circumstances. Yet, we know that no adaptations have to be made to employ patients who suffer from schizophrenia and that many such people are employed and have useful and constructive lives which, with support, many more could enjoy. If the reforms do not work for people with serious mental illness, the policy will fail. I look forward to hearing more on the Government’s plans for implementing these reforms, through the regulations, for the benefit of people with mental health problems.
7.31 pm
The Countess of Mar: My Lords, this Bill seems to have been an awfully long time on the way, so to speak, but I am as pleased as the Minister that it is here at last. A few points give me concern. I hope that they will be clarified by the Minister at this stage—or, perhaps, he can write to me, because I have many questions—and that we will be able to improve the Bill during its passage through this House.
For many years, I have been concerned about the manner in which claims for incapacity benefits from people with a diagnosis of CFS/ME, fibromyalgia, organophosphate poisoning, multiple chemical sensitivities and other diseases that are multi-symptomatic and
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Recently, I have been a member of a panel, led by Dr Ian Gibson MP, which inquired into the current state of research into CFS/ME in the UK. We heard evidence from many sources, perhaps the most distressing of which was from sufferers of CFS/ME who were severely ill and who had been sidelined by the social security system because nobody would believe that their illness was real. Such people are usually bed-ridden, often living alone and isolated from the community, and the aids that they need are unattainable. We were told that that had resulted in at least one death and several suicides. This is a welfare reform Bill. I do hope that the reforms made will take into account the seriousness of an illness that far too many men, women and young people in this country suffer, and that will offer them the security of knowing that at least the most basic of their needs will be provided for.
I will confine myself to Clauses 8 to 15. I am most concerned about the very large number, at least 27, of applications of the Henry VIII clauses, which will make it extremely difficult for either House to reject major secondary legislation that will affect the lives of many disadvantaged citizens. As the noble Baroness, Lady Thomas of Winchester, said so strongly, and as stated often in this House, that is not a satisfactory way to legislate.
Experience has taught me that, unless those responsible for the examinations are sympathetic, it is very likely that claimants suffering from the illnesses that I have listed will be given short shrift. I have written frequently to the Minister’s predecessors and have challenged them at the Dispatch Box—that includes the noble Baroness, Lady Hollis, who I am pleased to see in her seat, the noble Lord, Lord Hunt of Kings Heath, and even the noble Lord, Lord Skelmersdale, who resisted pulling my leg this evening. Inevitably, original decisions on claims have been overturned. I cannot immediately recall the proportion of refusals overturned on appeal, but my noble friend Lady Murphy said that the figure was 70 per cent, a huge figure. It leads to an enormous amount of stress for claimants and is a huge waste of public money. If the new system can be rationalised to reduce both those factors, I, for one, will be delighted. It grieves me that I receive many communications from frightened and anxious people or their carers.
Clause 8(2)(b) states that regulations will,
- “define the assessment ... [of] the extent to which a person who has some specific disease or bodily or mental disablement is capable or incapable of performing such activities as may be prescribed”.
Most of the illnesses that I have mentioned involve symptoms that fluctuate in severity and duration. Some sufferers get better, others do not. It is known that claimants will prepare themselves for an interview or medical examination by resting beforehand, and it may be that they perform well at the time. However, it
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Clause 8(3) requires evidence to be provided. I would be grateful if the noble Lord could indicate what that evidence might be. Under the current system, the evidence of the patient’s GP or consultant is frequently disregarded. Whose evidence will the assessors believe?
Will the Minister kindly explain the need for two almost identically worded provisions, subsections (1) to (4) of Clauses 8 and 9? Will he explain also the difference between “limited capability for work” and,
As regards Clause l0(1)(b), I have sought in vain for a clear definition of a,
That phrase has been used several times this evening. What is that support group, and will the Minister consider defining it in Clause 23? Will he explain more fully what the Government have in mind in subsection (2)?
Is it the Government’s intention that the healthcare professionals mentioned in subsection (7) will be appointed on the same basis as they are currently; that is, that the work will be subcontracted to a private company? What type of training will the professionals receive and from whom? One of the current problems is that examining doctors do not always have a good grasp of English, particularly when a patient has a strong regional accent. As the noble Baroness, Lady Murphy, said, often those doctors are not capable of distinguishing between different sorts of illnesses. Perhaps a computer would be better. Can we be given an assurance that that will not be a problem in the future?
Regarding Clause 11(2), what will be the qualifications of the people responsible for conducting the work-focused interviews? Subsection (7) states that an interview will be conducted by the Secretary of State, but I am sure that that cannot be the case. Who will it be?
What would be the position of one of the Secretary of State’s officials who, under this legislation, persuaded the claimant against his better judgment to take up a work-related activity which resulted in a serious deterioration in the claimant’s condition? I ask that because I am aware that, under some circumstances, cognitive behavioural therapy and graded exercises are recommended for people suffering from depression and chronic fatigue syndromes—with some success. That is not necessarily the case regarding people suffering CFS/ME, because, although they may be depressed and fatigued, they may have also a number of other symptoms that may not be picked up in a medical examination, and which can be exacerbated by exercise.
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Clause 13 provides for an action plan in connection with work-focused interviews. Subsection (3) makes provision for them to be provided to the person who is subject to a requirement to undertake work-related activity. Are those plans to be agreed with the person involved?
I have read and re-read Clause 14(1) and cannot understand its meaning. I would be grateful if the Minister could translate it into plain English.
The Bill is both necessary and timely. The system for paying benefits to people who are sick or out of work has become much more complex than it was when I worked in the Ministry of Pensions from 1959 to 1962. In those days, it seemed that everyone got two pounds and 10 shillings a week, whatever their condition, and the pension was two pounds and 10 shillings a week as well. I look forward to the Bill’s progress through this House.
7.40 pm
Lord Young of Norwood Green: My Lords, I thank my noble friend Lord McKenzie, the Minister of State, for his introduction, and I congratulate him on his new appointment.
Lord Oakeshott of Seagrove Bay: My Lords, he is not there yet.
Lord Young of Norwood Green: My Lords, that was a bit of anticipation on my part.
This is essential legislation, which seeks to modernise the welfare state. I agree with those who say that the change needs to combine compassion and care, but I think that we should look at Labour’s inheritance between 1979 and 1997. The number of people on incapacity benefit trebled, as people were written off to a life on benefits to hide the true number of unemployed. If numbers on incapacity benefit had continued to grow at the rate that they did under the previous Government, there would now be 4 million people on incapacity benefit. Unemployment doubled between 1979 and 1997; it twice hit 3 million. We had long-term youth unemployment, which topped 300,000 compared with just 6,700 today. We had a benefits system that was passive, providing little support and few obligations to encourage people out of benefit dependency and poverty. Over an 18-year period, child poverty more than doubled. That was the situation that this Government sought to improve, and in many areas, whether it is employment or reducing child poverty and benefit poverty, there have been significant gains.
As it was for others, it was a privilege for me to hear the noble Lord, Lord Morris of Manchester, give us an historical analysis based on his previous disability legislation. I believe that this Welfare Reform Bill has it right when it talks about the rights to benefit being accompanied by each person’s responsibility actively to seek work, recognising that some people, by virtue of their disabilities, will be unable to work, a point made by many noble Lords. Even changing the name of the benefit from “incapacity benefit”, which seems to define a non-changing, permanent condition, to “employment and support allowance” seems positive.
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I welcome the Government’s assurance that this is not about cutting benefits or forcing people into work, but I recognise the concern expressed by some. The noble Lord, Lord Kirkwood, expressed his anxiety about conditionality, and the noble Baroness, Lady Murphy, referred to the sanctions. They saw it in a negative light; I see it as a positive encouragement, although I recognise that disabled people face barriers.
We know from our experience with the New Deal and jobseeker’s allowance that successful support is founded on complementary benefit and support structures. The examples that we have had of the Pathways to Work pilots and jobseeker’s allowance give us encouragement. Transforming the gateway to benefit—the personal capability assessment—from being purely focused on establishing benefit entitlement to a much more constructive and proactive approach which focuses on capability is, I believe, the right way forward. It will examine not only what an individual cannot do but also what they can do and how they might be helped to improve their capacity.
I share the concerns of those who cite mental health problems. We know that the number of people involved has risen significantly from less than 20 per cent in the 1980s to nearly 40 per cent now. We want this new personal capability assessment to be more sophisticated so that it can better identify people with mental health conditions and tailor help to them more effectively. That means more resources, and I hope that that will be taken care of in the Minister’s reply. The policies are not about forcing people to seek work or undertake work-related activities that are detrimental to their health conditions; they are an attempt to break down the barriers faced by incapacity benefit recipients.
I share the concern of a number of noble Lords about changing employers’ attitudes, but the laudable desire to get people back into work will not succeed unless we can make a fundamental difference in this area. Some years ago, I tried to get a young deaf person back into employment and I remember the difficulty that I had with a large employer. It characterised itself as an equal opportunities employer yet seemed unable to understand the flexibility that it had to apply in recruiting someone with that disability who could make a positive contribution. There is plenty of work to be done in that area if the Government’s long-term aims and aspirations are to succeed.
We also need to break down the age barriers, recognising the huge demographic challenge ahead: by 2050, we will have 50 per cent more pensioners. The Government’s aspirations are laudable: 80 per cent of the working-age population in employment, reducing the number of people on sickness benefit by 1 million, and getting 1 million older people and 300,000 more lone parents into work. Those are challenging targets.
Having listened to the contributions of others more expert than me, I am not sure whether the current proposals will simplify the benefits structure, but I hope that they will. I agree with my noble friend Lord Morris of Handsworth that we have to tackle benefit fraud. That is essential if we are to maximise support for the deserving cases. Although the noble Lord,
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I was also interested in the comment of the right reverend Prelate the Bishop of Leicester on housing benefit withdrawal. I am sure that that would be the last resort. For those of us who have lived either in or close to estates where there are serious problems, the question is: what do you do about families who refuse to achieve a reasonable standard of behaviour? Do you let them continue to terrorise the rest of the estate where you live or do you decide that, as a last resort, and having attempted to help as best you can, some action has to be taken? I do not believe that the Government intend in any way to punish children. As I have already said, the record on reducing child poverty has to be acknowledged.
I do not want to end on a negative note, because I believe that this is positive legislation. It is time to reform our welfare programme. The Bill allies the right to work with the right to benefits for those who need help and care, and I commend it to your Lordships.
7.49 pm
Baroness Meacher: My Lords, I applaud the objective of the Bill to reduce by 1 million the number of people who are dependent on disability benefits. I should have thought that for people who, like me, have had a longstanding concern about unemployment, this would be a day of rejoicing, but I find myself deeply worried by what I regard as the unintended consequences of the Bill. To explain why, I shall concentrate on the 50 per cent or so of people who have a mental health problem as either their primary or secondary diagnosis. My noble friend Lord Low spoke eloquently about the impact of the Bill on physically disabled people.
I should declare an interest. I chair the East London and City Mental Health Trust and a clinical ethics committee for the Central and North West London Mental Health Trust. The aim of the Bill is to enable people to return to employment, but for those with fluctuating disorders, including most mental health disorders, the fear of taking a job is considerable. First, they face stigma when they return to work. They are very likely to face suspicion on the part of their manager and peers. They generally lack confidence and are likely to assume that they will probably fail. They will often be able to work only part-time, and on fairly low incomes. On top of that, they fear that if the job goes wrong, it will take months to restore their benefits. That fear is based on their personal experience; destitution is never far away from these people.
If the Bill could assist just one of those very real problems, it should do so. Reform of the linking rules would be an important start. These rules are designed to ensure a rapid restoration of benefits to a person
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I recently asked the manager of a jobcentre to talk me through exactly what would happen to a mentally ill person who takes and then loses a job. Her response was devastating. She explained the system as it was supposed to work and then she said, “Quite honestly, what usually happens is that the police pick them up and they are taken back to hospital. We can’t really help. We don’t really understand mental problems. There’s no doubt that mentally ill people really suffer in this system”. Those were the comments of a person responsible for operating these rules.
The linking rules will never work with this group unless they are truly automatic. Ministers tell me that the reason for the lack of automaticity is the need to avoid abuse. I would ask the Minister to consider whether it might be less costly to the Exchequer to restore benefit immediately and then to undertake checks when this approach would prevent extremely costly hospital admissions. We need only go back to the jobcentre manager for evidence of that.
Vitally important, too, is the need to extend the linking rules to include automatic restoration of housing benefit at the previous higher level for a person not in work. As noble Lords know, if you go into work, your housing benefit drops; if you leave work, in theory, your housing benefit rises. I know that the department has been considering that position and I should be grateful if the Minister could give the House an assurance that plans are in place to render the linking rules, including housing benefit, truly automatic for the most vulnerable group in the context of the new Bill.
I have thought long and hard about how those with fluctuating disorders, including those with moderate or severe mental health problems, can be helped by the Welfare Reform Bill. There is a positive and constructive way forward, but only on the basis that this entire group would be placed in the support group. I do not like to disagree with the noble Baroness, Lady Hollis, but sanctions will not work for people with moderate and severe mental health problems. The NHS and DWP need to work closely together to deliver the right package of help and support to return as many as possible of these people to employment for as much time as they can manage. I therefore greatly support the Government’s objectives; my only concern is about the means to attain them.
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