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In the Rethink briefing, which we have all received, the experience of a service user with manic depression is quoted. He said:
“In fact, the DWP kept me in the dark, delaying my benefit without telling me why. After all the stress of delayed benefits last September, I almost died with an aortic rupture”.
Many people simply do not have a social network and rely solely on healthcare professionals for support, as the noble Baroness, Lady Thomas, said. One suggestion was that post should be sent only at the beginning of the week, on a Monday or Tuesday. The letter would then be more likely to arrive on a work day, when the appropriate support bodies are open to deal with any concerns or misunderstandings that the claimants may have as a result. If the letter were to arrive at a weekend, this support would not be available and could lead to two days of unnecessary worry and confusion, and potential sanctions.
When invalidity benefit claimants are eventually migrated to ESA, this issue will be of particular relevance to them. Under the IB system, they will have had very little contact with the DWP, and any contact at all is likely to appear as threatening, whether in their own mind or to benefit entitlement. We have had little information about how people will
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Given the complexities that can easily arise in situations such as these, we really need to know what plans the Government have to improve methods of communication, which is what all of us have asked for.
5.15 pm
Lord McKenzie of Luton: It is impossible not to understand the strength of feeling on this issue, but I hope that what I have to say will allay some of those fears and satisfy all Members of the Committee who have spoken. This group of amendments deals what the Bill is asking people to do, how we notify them of what they need to do, and how a failure to meet a requirement is dealt with. We recognise that people with particular conditions, including mental health conditions and learning disabilities, may have particular barriers in understanding and meeting requirements. Some specific examples have been outlined today. However, that is not a reason to give up on these customers and not actively engage with them. Instead, it points to the need to build on the flexibilities and safeguards in Pathways to ensure all customers are able to engage fully. That is what we intend to do and I hope I can offer reassurance on that basis.
Before turning to the majority of the amendments, which deal with conditionality and how we apply it, I would like to address the specific amendments relating to the PCA under Clause 8 and 9. These clauses are, of course, different in the sense that the PCA deals with eligibility for the benefit and the support group. The subsequent clauses set out what is required of customers in the work-related activity group in return for receiving their full rate of benefit.
We have had the opportunity to discuss the personal capability assessment in some detail already in Committee. I am delighted that my noble friend has been able to satisfy noble Lords in such a clear way. But it is worth reiterating that the PCA will be central in the process for claiming employment and support allowance. It is essential that through the PCA we are able to obtain the right information about our customers in order to make a full assessment of their entitlement to benefit. Given the importance of this information to the assessment for limited capability for work, Clause 8 provides a power to treat customers as not having limited capability for work, but only where they have failed, without good cause, to provide the information requested or to attend or participate in the medical examination. We recognise the importance of ensuring that our customers are aware of and understand their PCA appointment.
The draft regulations under Clauses 8, 9 and 10 require notification in writing at least seven days before the assessment unless the customer agrees to accept a shorter period of notification in writing or otherwise. That includes the work-focused health-related assessment which we intend to undertake on
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In line with current practice we will continue to be flexible in approaching individuals in different ways, tailoring how we contact them according to their needs and what would be most effective for them. So, in addition to written communications, we will try to contact customers about the assessment by telephone if it is appropriate to do so. Customers will not, of course, be penalised if they have good reason for failure to comply with requirements. In particular, we acknowledge the particular difficulties that people with disabilities, especially those affecting their mental health, might face in complying with such requests. Regulation 8 of the draft limited capability for work regulations sets out a deliberately non-exhaustive list of the matters that should be considered when determining whether a customer has shown good cause for a failure to ensure that we can look at each individual's circumstances. The list specifically includes taking into account the nature of the customer's disability and the state of his health at the time, a point on which Members of the Committee have particularly sought assurance. I believe that this route of having the ability to look at individuals’ circumstances, while ensuring their health and disability are taken into account, strikes the right balance. The same approach to good cause is also taken in relation to limited capability for work-related activity. This is set out in Clause 9(4) of the Bill and in Regulation 7 of the draft limited capability for work-related activity regulations, which have been made available to the Committee.
On good cause, once on the benefit the principle of conditionality—that the state provides support both financial and otherwise, and in return the customer engages with us—is at the heart of this new benefit. Our successful Pathways to Work pilots have proven that this approach works for people with health conditions or disabilities.
Baroness Meacher: The Minister said that the Pathways for Work pilots have proved that the procedures work with people with disabilities. Can he confirm that the Pathways to Work pilots do not indicate that these procedures work with people with mental health problems? That is what the research shows, as I understand it.
Lord McKenzie of Luton: I do not believe that that is strictly correct. We acknowledge that there is concern that those with mental health problems are not being helped by Pathways to Work as much as other groups. The evidence from the pilots is mixed, and clearly more evaluation needs to be done. The IFS report’s findings on mental health have been widely cited, but the IFS says that we need to be cautious in interpreting those results from preliminary findings. The administrative data shows that the take-up of help through the choices package in Pathways areas is actually higher for those with mental health problems than it is for other groups, by around 4 per cent. Job entries are also around 2 per cent higher for those who have a mental health condition
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Baroness Meacher: Perhaps I may push this one stage further. Am I right in believing that the IFS work shows that there is no statistically significant improvement for people with mental health problems in their capacity to gain employment? There is the figure of 2 per cent, for example, whereas I understand that there was a significant improvement for people with physical disabilities. That is quite important.
Lord McKenzie of Luton: I think that that correctly cites the research, but the IFS said that it is too early to read too much into what it has done so far. I stress that a lot of research has gone on and has been commissioned. It is all publicly available, and I would be happy to send full details to the noble Baroness, although I am sure that she has accessed at least some of it. I stress that qualitative research shows good progress in helping people with mental health conditions and engaging when no one has before. We need to put all the research into context.
Lord Skelmersdale: Before the Minister moves on, is this not in part anyway what part two of the pilots is intended to establish? So far, as I understand it, they have been physical disability-oriented more than mental disability-oriented. This time around, the pilots are intended to take a more balanced approach, so that we will be more likely to see what the results will be with full roll-out. While I am on my feet, has any decision been made on when full roll-out will take place?
Lord McKenzie of Luton: On the latter, if we are looking at the provider-led Pathways for the other 60 per cent of the country, we are hoping to have phase one by the end of this year and phase two by April 2008. The noble Lord, Lord Skelmersdale, is not right to say that current Pathways pilots do not cover people with mental health difficulties. They deal with people with both physical disabilities and mental health disabilities.
Lord Skelmersdale: I did not quite say that. I said, using my own phraseology, that the original pilots were rather skewed in favour of physical disabilities, whereas the current pilots are designed to have a more balanced approach and therefore could be relied on more readily and more generally.
Lord McKenzie of Luton: I do not believe that that is a correct assessment. The existing arrangements are trying to reach both types of customer. We believe that the provider-led Pathways will bring innovative ideas so that we can spread best practice.
I touched upon what we believe the position to be so far in terms of the Pathways to Work pilots.
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Lord Addington: On the question of best practice, I specifically asked how best practice is being passed on here. There is also the question about best practice being put back into the system and ensuring that people get it down. Many of the groups I have spoken to that are involved in mental health have raised the problems of late diagnosis and late entry into the system; after all, more people will be coming into the system virtually all the time. How are the Government working out how this can progress without having to come back and make a new Bill? A little more guidance on that might help us later on.
Lord McKenzie of Luton: We are committed to writing to the noble Lord about our debate last time about spreading best practice. With regard to provider-led arrangements, there are clear requirements in the contractual arrangements for the dissemination of best practice. It is not something you can bottle, though; in many ways it is cultural. If we do not ensure that best practice is shared across the piece, this will not be as successful as it could be. Everyone has an interest in ensuring that we share best practice. That is easy to say, but more difficult to achieve, I acknowledge.
To return to my script, we took the bold step of moving beyond the old system of just giving financial handouts to customers. We have embedded the principle of the Government offering back-to-work support through the new benefit. Instead of abandoning people, that approach supports customers’ ambitions of returning to work. The success of the measures we have introduced bears repeating: we have more than doubled the job entries in Pathways areas compared with non-Pathways areas, and there has been an increase of more than 9 percentage points in employment for new customers after 10 and a half months.
Ultimately, central to the successful approach are sanctions for those who refuse to engage with us and have no good cause not to. That is fair, particularly on the vast majority who want to, and do, engage with us. The purpose of the sanctions is not to punish customers arbitrarily, but instead to ensure that there is a clear incentive to engage with the support on offer. That is reflected in the draft regulations we have published for Clauses 10 and 11, which will remove a sanction once the customer has participated in the conditionality requirement. In Pathways pilots the awareness of sanctions has led to customers engaging with us and sanctions being applied in only about 1 per cent of cases. We are not just requiring those subject to conditionality to engage in interviews. The work-focused health-related assessment will identify what an individual can do, any health-related barriers that prevent him from moving towards work and the health-related interventions that could help to break down those barriers. In time, and as resources allow, we will require customers to engage in work-related activity to help them overcome their barriers to work.
Before discussing treatment of a failure to meet conditionality requirements, I shall touch on how we notify customers of requirements to undertake interviews.
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The Countess of Mar: Before the Minister goes that far, he mentioned identifying the barriers to getting back to work. In the case of the guidance that has been issued for people with ME/CFS, one way to overcome those barriers is cognitive behaviour therapy and graded exercises. These two “treatments” have been shown to be very unsatisfactory for people who are severely affected by ME, but the new guidance does not make the distinction between people who are severely affected, those who are moderately affected and those who are slightly affected. If a group of people refuses graded exercise and cognitive behaviour therapy, on the basis either that they are afraid or that they know it will not help them, will they be penalised?
5.30 pm
Lord McKenzie of Luton: If we are talking about people who would be in the support group, there is no requirement to engage in work-focused interviews or work-related activity. If people are not in the support group, conditionality is attached to that but there is no requirement for individuals to carry out any specific type of activity or treatment. That cannot be sanctioned.
Before discussing the treatment of a failure to meet conditionality requirements, I shall touch on how we will notify customers of requirements to undertake interviews and activity. The draft work-focused interview regulations specify that the notification of a work-focused interview can be in writing or by telephone. Furthermore, they provide that the interview may take place in a customer’s home if necessary. The safeguards set out in the supporting material also specifically provide for making contact with customers before each work-focused interview to remind them that it is due, letting them know to get in touch if there is any difficulty with the planned date, time or place and encouraging advocacy support if needed.
These measures combine to ensure that we take multiple steps to ensure that our customers are aware and understand the requirement. When work-related activity is introduced, work-focused interviews will also be utilised to provide the customer with information and advice about the requirement to undertake activity and the ways in which they can meet it. That will be in addition to a written notification required by the regulations.
Additionally, as the Minister of State for Employment and Welfare Reform explained in another place, the Department for Work and Pensions is currently conducting reviews of the forms of the material, including letters, to ensure that they convey necessary information to customers as sensitively as possible. That has been done in close consultation with support groups and organisations and with individuals with mental health conditions. For all customers subject to conditionality, a sanction can be imposed only if they fail to meet the requirement without good cause. Our intention in providing for good cause when there is a failure to meet a requirement is to give protection to customers who are unable to participate for reasons outside their control.
As I have touched on previously, we have made draft regulations available to noble Lords for
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We are also putting a comprehensive package of safeguards in place, based on those in Pathways to Work areas. Safeguards include contacting customers to remind them of interviews or assessments, encouraging advocacy advice when necessary and identifying any issues from medical evidence that may impact on attendance. Additionally, when a customer has a mental condition or learning disability, a visit is made to a customer, with his representative if appropriate, if a sanction is to be imposed. As we roll out Pathways and introduce the employment and support allowance, we shall of course keep those under review to provide a good service to our customers.
I shall reiterate some clear commitments on our intentions relating to good cause for failure to meet a requirement to do work-related activity. We intend that when a person’s physical or mental condition makes it impossible for him to have met the requirement, that will be a relevant factor listed in the regulations relating to good cause. We also intend to bring forward safeguards based on those that we have set out for work-focused interviews. All those processes will ensure that the substantial protections that we offer customers in Pathways to Work will be brought forward as the employment and support allowance is introduced.
On the five-day period, customers must show good cause, but we recognise that a balance is to be struck in allowing customers reasonable time to show that they have good cause for not taking part in a work-focused, health-related assessment. The provision in the draft regulations is for people to have five working days in which to show that they have good cause, in line with the provision in Pathways for work-focused interviews. It would not be reasonable to let people postpone an assessment indefinitely by giving them unlimited time to show good cause for non-attendance. In addition, the certainty of knowing the date by which an explanation must be received and the point at which we can be certain that we can safely make a determination without good cause will help the timely and efficient delivery of the new benefit.
Some specific questions were raised that I should like to cover. We touched on the issue of the evidence on what has and has not worked, and I know that we shall have a substantial debate on CBT and all that surrounds it. There has been a suggestion that forcing people with mental health conditions to do conditionality will damage their health; we shall approach such cases
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The question was raised whether a work-focused interview at eight weeks could lead to a sanction for people who end up in a support group. The answer is no. Any failure to come to a week eight work-focused interview, if it is determined after that period that the person should be in the support group, would not give rise to any sanction.
I have tried to touch on the issues of good cause raised by a number of members of the Committee. This has been a good run-through of a very important issue. We all want this to work and we need to address the issues sensitively. That is our determination. I am sorry to hear about the particular case that the noble Baroness, Lady Meacher, cited, but there is a danger in extrapolating from a particular example to saying that it is the generality. A lot of effort has gone into serving all our customers.
There is one fact that many have dwelt on during the passage of the Bill—that customers who are on incapacity benefits after two years are more likely to die or retire than to return to work. That is the failure of the voluntary approach. Abandoning customers on that basis is, I hope, a failure of the past. Engaging customers to help them to achieve their ambitions through assessments, interviews and activity is the right thing to do. I hope that noble Lords will be reassured by the safeguards and processes that we have put in place, which will be brought forward into the new benefit. They provide real and substantial protection for customers, especially those with mental health conditions or learning disabilities. Accordingly, I ask the noble Lord to withdraw his amendment.
Lord Kirkwood of Kirkhope: After listening to the Minister’s response, I think that he must take from the important exchange that the Committee has just had the notion that it is completely unsafe to think that in the current circumstances, even with the experience of the pilots for Pathways to Work, the provisions deal adequately with mental illness. In my experience, they do not.
I declare an interest as a non-remunerated director of the Wise Group, which is a work provider in the Glasgow employment area. It was involved directly and indirectly in some of the Pathways work and it was quite clear that the new deal for disabled people was a huge asset and that the pilot roll-out promoted a lot of new interest. People were stimulated for the first time by the thought that they were actually getting active support. They came on down and got help—but it worked predominantly for people who had physical and other conditions. My experience may only be anecdotal—and I shall look at the IFS stuff, since it may be that the jury is out and we should all look at this matter more carefully. But in
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