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Lord Skelmersdale: I was not shaking my head at the Minister. Yes, of course she may.

Baroness Thomas of Winchester: It sounds as if there is a certain amount of confusion. It was interesting that the Minister said that the department was working with doctors and at some stage I would be grateful to know exactly what that means. The situation is not satisfactory and all of this should not be left to the appeal process, because that would be expensive and a terrible waste of time. There must be some tightening up.

Baroness Morgan of Drefelin: In terms of working with GPs and health professionals generally, ideas are being looked at for improving the flow of information, making forms easier, using electronic communication and working closely with GPs through the provision of information and training materials to help them to understand how they can help their patients by getting right behind this. That is the “carrot” side of things.

It is also possible, by monitoring the performance of GPs and involving Atos Origin doctors, to encourage them to speed up the process of information provision—and the department’s medical adviser could be brought in to encourage GPs and suggest that their PCT could be in touch with them with regard to their contractual obligations if they do not improve. All those discussions are going on to promote a positive engagement with GPs. So far as I am aware, they are doing quite well in promoting engagement. Of course, it is not just about GPs; other health professionals have an enormous amount to offer and have shown real willingness to engage and help their patients by providing ready information.

To answer the question of the noble Lord, Lord Skelmersdale, about when the information is required, it is mainly required before the assessment, but if it is required afterwards the decision-maker will take it into account, provided that the information is obtained in advance of a decision being made.

4.45 pm

Lord Skelmersdale: Is it sufficient, therefore, for the claimant to take the information with him?

Baroness Morgan of Drefelin: I am advised that we need a separate process for information to go from the GP to the Atos Origin doctor’s assessment.

Lord Skelmersdale: I am sorry to plug away at this, but does that mean that the first interview will not normally be held until the information is received? Is that one of the reasons why the whole operation is to take 12 weeks?

Baroness Morgan of Drefelin: I am advised that we have to be extremely mindful of the possibility of fraud if people bring information with them directly. There is a real need to ensure that there are auditable trails of communication between the healthcare professional and the assessment process.

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Lord Skelmersdale: I can understand that, but my supplementary question, if the Minister remembers it, was whether one of the reasons for the whole operation taking 12 weeks was that the first interview cannot be held until after the medical information is received direct from—the trouble is that we are talking about two different healthcare professionals, and it is getting very complicated—let us call this one the “medic”, and then perhaps we will be able to make some sort of distinction.

Baroness Thomas of Winchester: While the Minister is thinking about her reply, I have one quick question. Can the decision be overturned at any stage before an appeal? Suppose that the medical report comes in, let us say, five days after a decision has been made, can it be changed at that stage, or must it then wait for the long process of an appeal?

Baroness Morgan of Drefelin: The point about the reassessment of claims before the appeal stage is important. One of the key issues, when we come on to talking about appeals, is that the department has been advised that it could be more vigorous about gathering information in advance of appeals. Guidance has been issued on that, in order to use all avenues to ensure that where new information becomes available following a decision, all opportunities for reassessment are taken in advance of appeals.

Coming back to the timing of the provision of information, of course it is ideal to have as much information as possible before the assessment in Clauses 8 and 9 takes place. There are lots of reasons why information may not become available after a person has experienced incapacity. It may take some time for that person to adjust to their new situation. Lots of factors may influence what brings them to make a claim. The ideal is to have as much information as possible at the point of assessment, but where that information is not available, ideally it will come into the system as quickly as possible to avoid it becoming available only after a decision, when there would be a reassessment.

The most important thing is that we encourage health professionals to understand the benefits to their patients of getting behind the flow of information and making it happen as quickly as possible. It is only by that engagement in the process and by making it as easy as possible for all the professionals involved, by the use of electronic media or simplified forms, that patients, who are customers in the benefits world, will be able to access benefits and support that, we hope, can make a real difference to their quality of life.

Baroness Thomas of Winchester: I thank the Minister very much for that long reply and the noble Lord, Lord Skelmersdale, for joining in what has been a useful debate. I do not think that I have heard the term reassessment before, which was very interesting. In the light of our full discussion, I beg leave to withdraw the amendment.

Baroness Meacher moved Amendment No. 35:

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“( ) as to the manner in which a person may be notified of a requirement to attend such a medical examination as the regulations may require.”

The noble Baroness said: I shall speak also to other amendments in the group.

The amendments, which are supported by a number of organisations, including Rethink, Mind and Mencap, are intended to ensure that claimants with mental health and other problems will not be denied full benefits because their symptoms result in communication or procedural failures. I should declare an interest because I am chairman of East London City Mental Health Trust. I am therefore aware of the impact of benefit failures for our service users and our staff.

Lord Skelmersdale: I am sorry, but the noble Baroness is speaking so fast that it is quite difficult to hear her.

Baroness Meacher: I am so sorry, but I was mindful of the time. As has already been noted, the Welfare Reform Bill envisages that claimants will be invited to attend assessments and, if assessed as having limited capability for work but not limited capability for work-related activity, was subsequently be required to attend a series of work-focused interviews.

As someone who has had personal contact over many years with people with severe mental health problems, I confess to being very pessimistic about the likely consequences of that conditionality being attached to benefits for that group, despite the assurances given by the Minister in response to Amendment No. 32. I have no doubt that others, such as blind people, will also be extremely vulnerable in the new environment. However, I shall direct my remarks to people with mental health problems simply because that is where my experience lies.

That group has particular communication needs which present real challenges to benefit offices. I often think that I am glad that I am not one of the officers trying to tackle those very difficult problems. The reality at present is that Jobcentre Plus may be doing an excellent job with many of its clients but, sadly, it simply does not have the skills to deal effectively with people with mental health problems. Social workers tell me that they and others working in community mental health teams spend a great deal of their time troubleshooting—for example, preventing people being evicted from their homes because of the failures of the benefits system, principally arising from the communication failures between Jobcentre Plus staff and the claimant.

Service users’ symptoms or side-effects may leave them unable to focus on practical issues like the need for money or making sure that their rent has been paid. They may well fail to take the initiative to ask for a form to complete, to read the instructions or to fill in the form when it arrives. In short, people with mental health problems are unlikely to communicate consistently and effectively or to pursue the necessary set of procedures to attain what they need. Furthermore, people with severe mental illness may have an unexpected crisis on the day of an assessment

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or interview, and hence not turn up. If they are too ill to attend the interview, they almost certainly will not let anyone know why they have not arrived.

One of the most challenging problems for the benefits authorities is the fluctuation of symptoms. Perhaps people feel reasonably well on one day and will phone Jobcentre Plus to be told that they will be invited in for a medical assessment for benefits, but the next day they may become depressed again and for the succeeding week or weeks they may be in a bout of depressive illness and unable to function. But the jobcentre staff member has a note that the person phoned up and is due to come in for an assessment. All would seem to be well. When the claimant then fails to appear for the assessment and the jobcentre worker checks their notes, they are probably going to misconstrue the situation and the risk to the individual’s benefit is perfectly obvious. It is no one’s fault, but the system even as it stands does not cater for that kind of problem.

Even under the existing relatively benign system, problems arise when a service user changes their circumstances. That is a very particular point of difficulty. Perhaps, for example, they take up a job but fail to keep it and need to restore their benefits urgently. According to the linking rules, this should happen without a problem, and I am grateful to the Minister for his letter about those rules. However, I have to say that it does not actually address the issues I have raised about them, so perhaps we could have a discussion outside this Committee. The fact is that problems arise because the symptoms of the individual’s illness or the severe side-effects of the medication in the early stages of a relapse—when they have suddenly lost a job because they have become ill—mean that they do not answer letters or respond to phone calls, and the benefits are simply not paid. Too often, what actually happens is that the landlord threatens eviction, and on we go from there. Social services are contacted, or indeed members of my staff.

However, my big worry is that communication failures under the new system will create this kind of life crisis without there being any change in an individual’s circumstances. If they get to the point of receiving benefits, there will then be yet another interview, another challenge and another set of hurdles. So one of my concerns is the sheer number of actions and contacts that will be necessary in order to achieve and then retain an adequate income from the new ESA. Every claimant will have to negotiate one or more work-focused and health-related assessment, work-focused interviews once a month, and in time to arrange and attend work-focused activities. In our world, you have to break all that down and think of how many activities each of those things involves: responding to a phone call, opening a letter, reading the instructions, filling in a form, finding an envelope and a stamp to go on it, remembering to post the letter when all that has been done—if the individual ever reaches the point of doing it. These are actions which most of us hopefully can manage without too much difficulty, but you have to consider all of them as risk points every time there is a requirement for an

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interview or other action. In a bureaucratic world, we can simply forget the enormity of all this.

The methods of notification and communication will need to be sensitive, repeated where necessary, and involve checks to ensure that the claimant has really understood the position and is well enough to take the requested actions. To do this properly will require even more resources than the Pathways to Work pilots which, although as all noble Lords know, have been successful for a lot of people with physical challenges, have not been successful for those with mental health problems. It seems that there will be one of two outcomes: either people’s benefit will be set at or reduced to the jobseeker’s allowance, simply because they will fail this whole gamut of measures; or they may be granted employment and support allowance and then simply be neglected by the contractors who take on this work. In the latter case they will presumably remain on benefit indefinitely without any kind of help. But let us assume for a moment that the contractors will attempt to engage with this client group, in which case a failure to undertake any one of the actions that I have referred to will potentially put the claimant’s benefit in jeopardy.

5 pm

I return to my conversation with the Jobcentre Plus manager responsible for operating this system. I hope that noble Lords will forgive my returning to this—I mentioned it on Second Reading—but it is so relevant to what we are talking about now. When I asked her what happens to people with mental health problems when they come to her needing to restore their benefit, she said: “Quite honestly, what usually happens is that the police pick them up and they are taken back to hospital. We cannot really help. We don’t understand mental problems. There is no doubt that mentally ill people really suffer in the system”. She was referring to the current system without the conditionality envisaged in the Bill and without these repeated requirements to attend at various junctures for various assessments and interviews.

We should be aware that even those who are ultimately judged as entitled to membership of the support group, and thus not subject to any conditionality, may nevertheless, as I understand it, be required to undertake a work-focused interview after eight weeks—I think that that is correct. These will be severely disabled claimants, yet they too must show good cause—within five days, as I understand it—why they failed to comply with those requirements. Perhaps the Minister can assure us that a failure to comply with that requirement will not affect the support group benefit to which they have been assessed as entitled.

I certainly acknowledge that the answers to these problems are not straightforward. Only sustained personal contact and home visits will protect this group; and yet we know that that means resources, and we know that the DWP is facing a 5 per cent budget cut. So if conditionality is applied to vulnerable groups including people with mental health problems, I hope that the Minister can assure the Committee that the system will take account of the disabilities of the claimant and that he will give serious consideration to these amendments. I beg to move.

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Baroness Thomas of Winchester: From these Benches we support this large group of amendments. I shall speak specifically to Amendment No. 35 and then to Amendment No. 36 onwards.

I shall address the notifications point first. It is a truism, as the noble Baroness said, to say that people with severe mental illness have particular communication needs that must be respected to ensure that they receive the information they require and to ensure that unnecessary stress and anxiety are not caused by DWP communications as that may lead to relapse. One claimant commented:

Another example is the Saturday problem. People with mental illness report that receiving a letter on a Saturday causes particular problems because offices offering support are closed on Saturdays. Poor communication was identified in some of the Pathway pilots.

Turning to the “good cause” provision, we come to a particularly important part of the Bill. Amendment No. 36 simply states that the reason certain actions have not been carried out might be due to a person’s limited physical or mental functioning. The whole concept of “good cause” needs to be thoroughly examined. It is an extremely worrying aspect of the Bill. In Committee in another place, it was said that the Government intend to set out in regulations the matters that will be taken into account when determining whether a claimant has shown good cause, although the list will not be exhaustive. Although flexibility is welcome, some factors must be taken into account. As the noble Baroness said—I am repeating a lot of what she said—people with mental illness may not open letters or answer the telephone, due not to ill will but to forgetfulness, anxiety or fear, some of which may be associated with the side effects of medication. They may thus be unaware that they should attend a medical examination, or they may be particularly unwell on the day on which they are supposed to be examined.

Both Rethink and Mind are emphatic in their belief that regulations should specifically exempt people from having their entitlement revoked due to non-attendance, if this is due to a health condition. If this does not happen, and such a person is sanctioned, it is more than likely that that person’s health will worsen through worry and stress about income, moving them even further from the labour market. There is also a concern that DWP staff are not necessarily good at recognising people with mental illness, and they may dismiss such people as lazy rather than in need of understanding and support. We are calling not for a long list of conditions defining good cause but for the basic principle to be acknowledged that a person’s non-compliance with conditions of entitlement may be due to his or her mental illness.

The Countess of Mar: I wholeheartedly support the amendment, which goes right to the heart of what I have been saying for years about people with ME or CFS. I am sure that the Minister and other noble Lords do not want to be tired by me telling them once

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again what I believe about these people, who suffer from a fluctuating illness. The stress and pressure of having to fill in forms can sometimes be too exhausting for them, and they simply cannot cope. They then take to their beds and eventually die because they cannot get any income, food or support. I therefore wholeheartedly support the amendment.

Baroness Murphy: I add my voice in support of the amendment, on which the noble Baroness, Lady Meacher, has expounded so excellently. I shall not go on at length. As a general psychiatrist, one is subjected to the often ongoing saga of someone attempting to get benefits and their constant failures to turn up at the right time, creating enormous frustration for those who are trying to provide care for them. The Bill has the potential to help enormous numbers of people with mental health problems to get back into work-related activities and work. For that reason, we broadly support it. However, for those with serious ongoing mental health problems, it is a big mistake to put this barrier—this conditionality—in the way of getting people into the system so that they can be reassured by it and feel confident so that they can gradually get back to work. I very much support the amendment tabled by the noble Baroness, Lady Meacher.

Lord Addington: I shall briefly add my voice to this. One of the problems with this group of amendments is the incredible diversity of the issues. Off the top of my head, I would say that mental health is probably the best example. Virtually every other disabled group will have some type of problem. My expertise, such as it is, involves those with literacy problems, including dyslexia. Someone with a bad short-term memory who is bad at reading letters and who may not have a phone is a problem. With the best will in the world, there will be problems here. If you place this in some sort of multiplier, determining what is going to be the correct type of communication will be difficult. I would certainly be more relaxed about this process if the Minister could give me an idea of how they will compile, for example, case studies, best practice and a database. We may be able to build up a best practice model if we have a process that we can feed into, which will help. Unless we get this right, however, the potential benefits of this system will start to fall away, because people who for a variety of reasons simply have a great many problems organising their lives and communicating through the normal channels will slip through the net. If this is not addressed, we are in effect creating a whole approach that will fail for large groups.

Lord Skelmersdale: There is so much consensus around the Committee that it is difficult for someone whose amendments are grouped with those of the noble Baroness, Lady Meacher, to get a word in edgeways. However, that is exactly what the Minister asked for at Second Reading and that is what he has most certainly got now.

My amendments in this group, like those of other noble Lords, explore the Government’s intentions for the definition of “good cause”. The rationale behind

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the idea is clear. After all, if a claimant has a good reason, he should not suffer a penalty, but it is in no one’s interest, least of all that of the claimant, if the work-related activity is not taken seriously. However, there are various practical points that I have not yet quite got to grips with. What criteria are the Government using to measure “good cause” for missing a work-related activity or health-related assessment? Will “good cause” cover behaviour resulting from a person’s disability? As the noble Baronesses on the Cross-Benches said, this might, but not necessarily, be a mental disability.

There is a danger that, without clear guidance from the Government, every separate provider will apply the Bill differently. A postcode lottery in this respect is inherently unfair, but it could also lead to unnecessary confusion and worry about the rigour of conditionality and the requirements that will be placed on the claimant. I therefore look forward to hearing the Minister’s response to these questions and hearing more about how conditionality will be applied in practice.

I support the amendments of the noble Baroness, Lady Meacher, which deal with the manner of communication with clients. In my meetings with lobby groups, many concerns have been raised about how organisations undertaking the assessments and the work-related activities will communicate with claimants. As the noble Baroness, Lady Meacher, said, this point is particularly important for those with mental disabilities, but thoughtlessness in this area could have a significant impact on many other claimants, too. It has been brought to my attention that some mental disabilities often lead to behaviour which makes communication difficult, such as a refusal, as we have heard, to open post. Given the possibility of sanctions should a claimant be considered to be avoiding work-focused interviews or health-related assessments, it is very important that this behaviour is fully understood in the context of the claimant’s disability and allowances made.

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