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Let me make it clear that applications were scored only by doctors. Preparatory work was done by the individual deaneries, which were responsible for the administration of this system, to help doctors in the most effective way possible. Again, I will want to listen to the feedback from doctors involved in both the short-listing and the interview process to see if there are areas where improvement can be made. That is the whole purpose of the review team. I offer enormous thanks for the time the doctors involved have given up so far and will give up in the future. However, it would not be fair to say that they were not given appropriate guidance and support, and I am keen to learn any lessons that have come as a result of their experience.

Lord Colwyn: My Lords, the numbers in the dental profession are much smaller, but is the Minister aware of any plans to expand this recruitment and selection process to specialisms in dentistry?

Lord Hunt of Kings Heath: My Lords, I am not, but I am ever open to suggestions.

Lord Rea: My Lords, it is perfectly clear that a number of candidates of very high calibre have been missed and not offered interviews. Perhaps this is a question for Professor Douglas’s review group, but does this not have a knock-on effect in that those who have already received interviews may be some of those who are perhaps not of such high calibre? There is a limited number of posts and some of the people who are perhaps not the crème de la crème may already have been recommended for them—or if not appointed. Is this not going to somewhat queer the pitch even if all those doctors who have been refused interviews eventually get one?

Lord Hunt of Kings Heath: My Lords, I can tell my noble friend that my officials have taken careful advice on the appropriateness of the procedures that are now going to be adopted. No appointments have been made in round 1. I can also tell him that the initial feedback from those doctors who have already undertaken interviews is that a very high standard of candidate has been short-listed. But the importance of the Statement last Friday is that it enables us to

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strengthen the process in round 1. It means that all applicants at ST1—the first level of the specialty training—who have not been short-listed for any interviews will have their application reviewed and may be offered an interview in round one. That is the most appropriate way to try to deal with the issues immediately, but as I have said to my noble friend, we have sought advice and we are confident that this is the correct way to proceed.

Lord Brooke of Alverthorpe: My Lords, I would like to pick up on the point made by the noble Baroness, Lady Barker. When everyone embarked on this journey we were in general agreement that there was a case for change; that life was not perfect under the old regime. First, I would like to know when these discussions commenced. Secondly, could the Minister indicate at which point, in his opinion, things started to go wrong? Thirdly, I would like to address a question to some of my colleagues here. How do we know that these people who have not been selected are of high calibre? Who is making the judgment about this?

I was in one of our famous hospitals on Friday afternoon, being tended to by a young junior doctor who told me that she was generally in favour of the changes being proposed. She was of Asian extraction. She said she believed that under the system she would have a much better chance of being able to compete for the better posts that were to be filled. She was generally in favour, but she believed that there would be strong resistance—as there always is, in her opinion—to any change, particularly from consultants and from people of the old school, as she described it. She says there is still an old-boys system operating which she found quite unacceptable—I raised this with the noble Lord, Lord McColl, at lunchtime. There will be a whole range of different views on this, but when does the Minister believe that the situation will be resolved to, as is hoped, everyone’s satisfaction? Those of us who do not have a vested interest other than simply being patients in the NHS want to ensure that, as the Government proceed with their programme of modernisation, there is a direct link between delivering the agreements reached by the stakeholders and the way in which those stakeholders are subsequently rewarded with the taxpayers’ money, to which we all subscribe.

Lord Hunt of Kings Heath: My Lords, I understand that there have been intensive discussions about the new system among all the stakeholders I have mentioned over the past four years. My noble friend then referred to the old system. Of course, one of the problems that has always been perceived within it has been the question of whether there was an old-boy network. There has been some evidence of that. But there were also concerns that junior doctors went from job to job without properly focused training. As I have said already, junior doctors often applied to many different institutions. Often hundreds of applications were received for one post. The whole system was completely unsatisfactory. That is why the stakeholders got round the table to devise a new system. I have no doubt whatever that coming out of

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this will be a fairer, better approach to the selection and training of doctors to go on these important, specialty training programmes.

Equally, it has been clear that there have been some practical teething problems with some of the deaneries and the way the process has been approached. The purpose of the review team is to learn those lessons and put things right that need to be put right and then to proceed with the general principles of a fair process designed to ensure that the best possible doctors are selected for specialty training programmes to the benefit of the National Health Service and the people of this country.

Welfare Reform Bill

5.40 pm

Consideration of amendments on Report resumed.

Clause 10 [Work-focused health-related assessments]:

[Amendments Nos. 17 to 21 not moved.]

Lord Addington moved Amendment No. 22:

The noble Lord said: My Lords, Amendments Nos. 22, 38 and 42 have the same basic principle. We know from the draft regulations that if a person fails to get to the interview, they have five days in which to lodge the reason why they had good cause to fail. Virtually everywhere else in the system, a person has a month to appeal and show good cause. I have here examples of why people might fail to attend and why this might not be appropriate, but one example sums this up: what happens if a person is knocked over on the way and is unconscious for six days? Why can we not have something to take care of that? A more frequent example might be mental health problems et cetera where a person has a mini-breakdown or a bad episode which takes them out of commission for that period of time, and they are unable to get in contact themselves and people cannot get in touch with them. They have lost track.

According to my information, in the rest of the system a person has a month in which to react and register, and my amendment would bring this in line. The five-day period is far too short and arbitrary. It does not allow for variations in anyone’s life, let alone the lives of those who are slightly more chaotic than the rest of us. I hope that the Minister will be able to assure us that this five-day period in the draft regulations will not be rigidly applied. If it is, people are bound to be left very short of money, possibly affecting their family and dependants. I beg to move.

Lord Taylor of Holbeach: My Lords, my noble friend and I have tabled Amendment No. 23 in response to concerns that have been raised by the Government’s intention to give claimant customers just five days in which to show good cause for his or her failure to attend or to take part in the work-focused health-related assessment. The argument could equally well apply to any of the activities or interviews that will be subject to conditionality. We accept that some time limits

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should operate, but the test should be reasonableness rather than prescription. As it is, five days seems a rather short time in which to insist that a claimant customer must come up with proof, even if they have a further month to bring in new material. Of course, a claimant customer should be required to make all reasonable effort to explain why he or she missed an interview, but why can this not be all that is required?

Lord McKenzie of Luton: My Lords, the work-focused health-related assessment is a key component of providing support to return to work. It is the new, forward-looking and positively focused part of the transformed personal capability assessment. We believe the work-focused health-related assessment has a vital part to play in customers moving away from a dependency on benefits and into work, and we want all those entitled to the employment and support allowance to take part. Similarly, the work-focused interview is crucial to effective engagement with customers. It is the gateway to the advice, rehabilitation, financial assistance and other provisions available in Pathways to Work areas. Work-related activity will provide a vehicle for customers to take practical steps and move closer to the labour market.

It is central to our welfare reforms that customers engage with the support that is available. We believe that when it is reasonable for someone to participate, there should be a requirement for them to do so. Ultimately, a failure or refusal to take part for no good reason can lead to sanctions. However, our aim is that the rules should be applied fairly and sensitively. We use the concept of good cause because we know there will be times when customers cannot reasonably be expected to comply with a requirement. In these circumstances, a sanction will not be imposed. We have no intention of imposing sanctions when a reasonable explanation is offered for non-participation.

As I said in Committee, the draft regulations for Clause 10 include matters that are to be taken into account in determining whether a customer has shown good cause for not taking part in an assessment. These include the state of the customer's health and the nature of his disability at the time of the assessment. The draft work-focused interview regulations set out a non-exhaustive list of matters that may be taken into account in determining whether a customer has shown good cause for not taking part in an interview. These are intended to cover a wide range of possible circumstances and will help ensure fair treatment for all, including the most vulnerable. This will include customers whose physical or mental condition will sometimes mean that it would be impossible to expect them to take part in an interview at a given time. The safeguards listed in the supporting material provided to the House include visiting every customer, with their representative if appropriate, with a stated mental health condition or learning disability if a sanction is to be imposed.

Within the context of the safeguards that I have outlined, it is not unreasonable to expect that in most cases, customers who are unable to participate will be

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able to provide an explanation. Again, in most circumstances, it is not unreasonable to expect that explanation within a few days. The draft work-focused interview regulations and the draft work-focused health-related assessment regulations refer to five working days. However, the draft work-focused interview regulations provide that if a sanction is imposed for a failure to show good cause, this decision can be revised if within a month the customer provides relevant information showing good cause that could not reasonably have been brought to our attention within five days. We are still considering whether a similar provision is needed in respect of work-focused health-related assessments.

Without the provisions in the Bill as it stands, my concern is that fewer people on the employment and support allowance will engage with the help and support provided to assist them to return to work. The amendment would give customers unlimited time in which to show good cause and would introduce unacceptable uncertainty into the conditionality procedures. This would seriously undermine the conditionality and sanctions regime. I do not believe that noble Lords intend that, but it could be a consequence of their amendments. I hope that I have been able to reassure noble Lords that the protections around good cause are a reasonable approach and a fair way to proceed.

Lord Addington: My Lords, is the five days a guideline or an absolute, which is important for both of us?

Lord McKenzie of Luton: My Lords, five working days is the period in which a response is required and is a reasonable period of time in which to show good cause. It is the same as that used in Pathways to Work, and we have received no evidence of problems. If someone does not turn up for a work-focused interview and subsequently shows good cause, that could be taken into account. The protections for “good cause” are real and substantial, particularly focusing on the health of the customer involved.

Lord Addington: My Lords, I think that that was close to saying there is some flexibility, but we will have to have a look at that. Perhaps I should say that I hope that that is the interpretation to be drawn from what the noble Lord has said. Therefore, provided those who are more expert in this area of law than I make that interpretation, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 23 to 28 not moved.]

Baroness Meacher moved Amendment No. 29:

The noble Baroness said: My Lords, I will be extremely brief. This apparently minor amendment, if accepted by the Minister, could avoid many unnecessary appeals and the uncertainty and worry for claimants who are wrongly assessed. The amendment would ensure that assessments of potential ESA claimants would be

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undertaken by suitably qualified people. Historically, mental health assessments were often undertaken by people with no specialist knowledge of mental illness. The result was an unacceptable number of errors, as evidenced by the extraordinarily high level of successful appeals in this category. I hope that the Minister will agree that the new, more demanding and less secure system should be based on assessments by professionals who have the knowledge base to understand the employment implications of different diagnoses and clusters of symptoms, as well as the likely consequences of different medications.

As noble Lords know, the assessment is based on functional capabilities rather than diagnoses under the new system. Nevertheless, considering the descriptors in the mental, cognitive and intellectual function assessment, the task surely requires some judgment based on the diagnosis of the claimant. To take one example, in descriptor 19(e) on dealing with other people, the task is to assess whether the claimant is,


It is difficult to imagine making a true assessment of those types of issues on the basis of a question and answer session unless the interviewer has a good understanding of a person's mental health problem and the treatments available to deal with it.

Perhaps the Minister could advise the House what stipulations will be made about the qualifications and experience of people approved to undertake mental health assessments. I hope that he will agree to this amendment. I beg to move.

Lord Oakeshott of Seagrove Bay: My Lords, I support the amendment in the names of the noble Baroness, Lady Meacher, my noble friend and myself. The noble Baroness made the points very clearly. We support them and look forward to hearing the Minister’s answer. My Amendment No. 89 in this group deals with the definition of healthcare professionals.

I do not propose to repeat the extensive discussion that we had in Grand Committee, but I thank the Minister for the letter he wrote to me on 6 March attempting—only attempting, I am afraid—to clarify the Government's position. It contains a lot of talk about appropriate skills and the department's chief medical adviser, but it does not clarify what I can only call the grey area at the end of what the Government are talking about. We all agree that a doctor, nurse, occupational therapist or physiotherapist registered with the Health Professions Council is clearly a healthcare professional. But can the Minister give us a proper answer about what other categories can or will be included and on what basis? Our definition in Amendment No. 89 describes a,

I hope that he accepts our amendment.

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Lord Skelmersdale: My Lords, there can be no dispute of the need for healthcare professionals to be properly trained in the disabilities of their clients—whether physical or mental. But it is equally essential to use occupational therapists, especially in helping the personal advisers understand what treatments and medical aids there are to help overcome the limitations, which may not have been suggested to him or her by the original medical professional with whom he or she dealt before applying for ESA.

Baroness Morgan of Drefelin: My Lords, Amendment No. 29 would ensure that healthcare professionals carrying out work-focused health-related assessments are suitably qualified to do so. As currently happens with Atos Origin doctors, all healthcare professionals who conduct work-focused health-related assessments will undergo training specified and agreed by the department's chief medical adviser, before being approved on behalf of the Secretary of State to carry out assessments. This will ensure that any healthcare professional carrying out a work-focused health-related assessment is suitably qualified to carry out all aspects of that assessment.

Baroness Meacher: My Lords, what depth of training will these people receive? It is just not the same thing if someone is sent for a little training before they do this work but they do not have the in-depth qualification of a health professional appropriate to the particular disability. There is a tendency in government in general to think that one can just provide a few days or a week of training, but then you do not have a suitably trained healthcare professional.

Baroness Morgan of Drefelin: My Lords, I hope that I can reassure the noble Baroness further. When I talk about Atos Origin doctors I mean medically qualified doctors. I will expand on that further if I may.

Appointment by the Secretary of State will ensure that any healthcare professional carrying out a work-focused health-related assessment is suitably qualified to carry out all aspects of that assessment and has been trained to the standard that the Secretary of State considers appropriate. If the healthcare professional does not have the appropriate qualifications or has not been trained to the appropriate level, he or she will not be approved to carry out the assessments.

The healthcare professionals will receive training to equip them with the skills needed to identify the health-related barriers to work and possible health interventions which will be required when conducting work-focused health-related assessments.

I turn now to Amendment No. 89. Clause 61 relates to the use of healthcare professionals in social security benefit assessments and covers a range of benefits. However, the definition of a healthcare professional is also referred to in Clause 10(8), which relates specifically to the new benefit, ESA. It is important that we maintain a consistent position throughout the legislation.

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I understand the concerns which have been expressed about the need to ensure that only appropriate healthcare professionals are used to carry out assessments. We all agree that only properly trained healthcare professionals with appropriate skills should be used to carry out medical examinations. As I have said, we have the added security and safeguard that all healthcare professionals must be approved by the Secretary of State before they can undertake medical examinations.

We have no plans to use healthcare professionals who are not members of a regulated profession. Bearing that and the Government's commitment towards regulating more healthcare professions in mind, we agree with the principle behind the amendment and believe it would be appropriate to look again at the way we have approached the structure of the legislation here. I believe that we are able to meet the concerns that have been raised, while retaining flexibility to use other professionals from regulated professions, should it prove appropriate to do so to address any skills gap which may be identified in the future.

With the House's agreement, we would like to take away Clauses 61 and 10 and consider further an alternative wording which would address noble Lords' concerns. We discussed this at some length in Grand Committee and my noble friend has written to the noble Lord, Lord Oakeshott. I believe that we will be able to return at Third Reading with a practical solution which will meet noble Lords’ concerns.

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