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I shall deal with one point about the training that all healthcare professionals get in assessing mental health conditions. We will ensure that that remains up to date and effective. For ESA, there will also be assessments of people with learning difficulties, many of whom are currently exempt from undergoing a PCA. We shall ensure that people get the appropriate training.

As for appeals, most of them take place because the relevant information is unavailable to the decision-maker at the time of the decision. That is something that we discussed in Committee.

I hope that, given the suggestion that I have made, the noble Baroness will withdraw the amendment.

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Lord Oakeshott of Seagrove Bay: My Lords, I listened carefully to the Minister’s remarks and I thank her for suggesting that there might be some helpful movement in our direction. However, I cannot quite see why she does not simply accept the wording of paragraph (d) in Amendment No. 89, as it seems pretty clear and deals with the point. I should be happy to change the wording, depending on whether she wanted to say “regulated by” or “registered with”, but it is still a very important principle that other healthcare professionals should be regulated by or registered with a,

and that there are no further loopholes or amendments. I kept hearing the Minister talking about “appropriate” and the Chief Medical Officer, but that is a circular argument. On the basis that she

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has accepted paragraph (d) of my amendment, perhaps with slight wording changes, which is what I hope that I am hearing, I shall be happy not to press the amendment to a Division.

Baroness Meacher: My Lords, I, too, thank the Minister for her comments and her agreement to take the issues away to review them further. She made the point that assessors are generally medical practitioners. However, the point is that a lot of GPs do not have any training in psychiatry, believe it or not; they chose all sorts of specialties in which to train, but they would not necessarily have had six months’ training in psychiatry. The point that I hope the Minister takes away is that it is important that, if people are doing mental health assessments, they have training in mental health.

I am grateful to the Minister for agreeing to take these matters away and hope that she will take that into account and agree that people need to be suitably qualified. By that we mean that they should have had considerable training and experience in handling these complex matters. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 30 not moved.]

Lord Skelmersdale moved Amendment No. 31:

The noble Lord said: My Lords, this amendment would implement a rather more substantial modification to the Bill than my previous amendments would have done. The key part of getting a customer to consider taking up work or work-related activity is the interaction between the personal adviser and the claimant. The amendment would introduce the personal adviser—and, thus, the positive support for the claimant that he or she should provide—at the earliest possible stage of the process.

As I understand it, the work-focused health-related assessment currently appears rather clinical. After undergoing a tough eligibility test a claimant is required to go off to another test to be further questioned, this time with little or no explanation about what is to be achieved and what happens next. The personal adviser could and indeed should provide that.

I understand why further medical assessment will be necessary. The first eligibility assessments are tightly defined by the descriptors whereas I imagine the assessment here would be much more wide-ranging and might even include some medical assessment of the customer’s condition. The Minister will remember that I asked about that at the meeting that he so helpfully provided in the department the other day and was told that it would not involve complete undressing but that there might be a need for the customer to remove his jacket, for example, so that tests could be carried out on the flexibility of his shoulders or elbows. I am sure that the Minister will remember that. It is hardly invasive or embarrassing, so there does not appear to be a good reason why the personal adviser should not be present. It would make

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the assessment even more useful if it encompassed not only the medical possibilities and treatments that might be available but the non-medical training and activities that the claimant could undertake.

The Minister raised the issue of confidentiality, which must place some limit on how involved the personal adviser can be, but I still feel that there would be a role for the adviser to play in fulfilling the work-focused element of the assessment more effectively and moving the claimant through the system quicker. That is to everybody’s advantage, not least that of the claimant. I beg to move.

Lord Addington: My Lords, I add my support to this. The WFHRA sounds like some appalling terrorist group—

A noble Lord: It may well be.

Lord Addington: My Lords, yes it may. If you brought in the advisers while you tried to discover somebody’s capacity and get information together on them, there would be a degree not of joined-up government but of joined-up delivery of service, which is a very sensible idea. Trying to get professionals to speak together, cross-reference what is going on and to talk to the person involved is surely a good idea. I hope the Government will bring this in; I see no reason why they should not.

Baroness Morgan of Drefelin: My Lords, the work-focused health-related assessment—or WFHRA, as it is becoming called—will look at residual capability; that is, it will discover what the person can still do despite a disabling condition. It will also identify health-related interventions that could enhance that residual capability.

The report of the assessment will go to the personal adviser who will carry out work-focused interviews with the customer. The customer and, with the customer’s consent, his GP will also receive copies, but the report's main purpose is to provide information for the personal adviser about health-related issues, on which the personal adviser cannot be expected to have the necessary expertise.

I can understand the need to take a holistic view of a customer in relation to work-related activity and to address all factors that may act as barriers to work. That is where the personal adviser idea could be coming from. It will be the role of the personal adviser to explore with the customer such issues as the need for training or social barriers to work. We are using healthcare professionals to carry out the work-focused health-related assessment because they have the necessary skills, which personal advisers do not, for assessing a customer's residual capability and assessing and advising on any health-related interventions that would enhance that capability.

Requiring personal advisers to attend work-focused health-related assessments would not necessarily be a good use of the resource or skills at our disposal. The personal adviser would not be able to participate in the entire assessment, because they will not have the

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health-related skills to which I referred. For example, the assessment will identify when health-related interventions are needed, such as a course of physiotherapy or cognitive behavioural therapy, which would help customers to improve their capability and move closer to the workplace. It would not be realistic to expect personal advisers to be able to assess whether such an intervention would be appropriate for individual customers. It is better that the personal adviser's skills be used where they will add most value, carrying out work-focused interviews, and that the work-focused health-related assessment is left to the healthcare practitioners, for all the reasons that we have just debated, as they have the expertise to fill the gaps in the personal adviser's skills. In designing the work-focused health-related assessment, we are carefully considering what information will be most useful to the personal adviser. We shall seek feedback from personal advisers, which will be very important, when we pilot the work-focused health-related assessment in the near future.

I fully understand the sentiments behind the amendment. As we discussed in Committee, we are trying to achieve an effective use of skills and division of labour between health professionals and personal advisers. Following this short debate, I hope that the noble Lord will consider withdrawing the amendment.

Lord Skelmersdale: My Lords, perhaps I should have read out the amendment, because the argument that the Minister has just produced, that the health professional would be sufficient for the purpose, is unquestionably right, but the amendment states that the health professional and a personal adviser should be at the interview/assessment together.

The importance lies in what the noble Lord, Lord Addington, in referring to an earlier amendment, called the holistic approach—in this case, delivering the service together. The sooner a personal adviser is in contact with the claimant, the better it must clearly be. I have not yet heard any argument against these two individuals being present together at the same interview, but I have no doubt that I am just about to hear one.

Baroness Morgan of Drefelin: My Lords, perhaps I have not been as clear as I should have been on the practical implications. We are talking about 300,000 WFHRAs in 100 centres and a current figure of 1,000 personal advisers. What the amendment proposes would not be an effective use of the personal adviser resource. We might need eight to 10 personal advisers in each centre to carry out the WFHRAs. I understand the noble Lord’s desire to give the best possible service to customers and to ensure that the work-focused health-related assessment is accessible and appropriate for each customer, but his amendment is not a practical way of going about it. Highly trained, expert health professionals will deliver the work-focused health-related assessment. It will be targeted at delivering the information that the personal advisers need. We are carefully using the pilot schemes to hone the interview and the reports that go to personal advisers. I hope that that practical information will encourage the noble Lord to think again.

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Baroness Hollis of Heigham: My Lords, is not the Minister effectively saying not only that many of those personal advisers would do nothing else but sit in on other people’s interviews, thus not allowing them to use the skills in which they receive specialist training—supporting moves back into the labour market, testing work and so on—but also that there could be a real problem in terms of tribunal review if a personal adviser who becomes a decision-maker has the decision in which they took part reviewed? That could apply to two stages: not only the interview but subsequently the benefit allocated. That would put the tribunal procedure in a very difficult position. Will the Minister confirm both those points?

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Baroness Morgan of Drefelin: My Lords, I endorse what my noble friend said. We need to think also about the cost. We are looking at a very carefully balanced division of labour and trying to use the skills of the health professional and those of the personal adviser where they are most needed. If we had a requirement for additional personal advisers—let us say, 500 more—that could cost, I am advised, around £10 million.

Lord Skelmersdale: My Lords, the amendment has elicited more information than I had expected. If there are 300,000 assessments in any one year and currently 1,000 personal advisers, one wonders how many medical professionals there are or will be. Are there more or fewer than 1,000?

The noble Baroness, Lady Hollis, made a point about tribunals. I do not see how the assessment or findings of the tribunal could be affected by someone who, as she described them, is just sitting there.

Baroness Hollis of Heigham: My Lords, I meant that if somebody chooses to appeal a decision, the position of the adviser may be compromised by having taken part or sat in on the original medical examination.

Lord Skelmersdale: My Lords, this discussion is rapidly beginning to sound like one that we would have in Committee. The noble Baroness’s point presupposes that the personal adviser will advise when matters proceed to a tribunal. That is extremely unlikely and undesirable.

I am not convinced by the Minister’s argument. I simply cannot see the disadvantages of my proposal, because the personal adviser would not interfere in any way with the activities of the health professional.

Baroness Morgan of Drefelin: My Lords, perhaps I may stress the risk of upsetting the balance between resources carefully allocated to health professionals working with Atos Origin doctors, of whom there are more than 1,000, and undertaking work-focused health-related assessments, and those allocated to personal advisers, who sometimes meet clients many times, as we know, to get customers closer to the workplace through their knowledge of local

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workplaces and the local employment market. Ideally, we would not want to have two professionals working in one interview. The most effective use of resources would be a division of labour between the expert health professionals and expert personal advisers, working to their different but very important remits.

Lord Skelmersdale: My Lords, that added information gives me a fraction more hope. The Minister has finally driven me off the idea of seeking the opinion of the House on this amendment. I shall withdraw it, but with the proviso that I shall study even more carefully than usual the Official Report tomorrow morning and reserve the right to come back to this at the next stage of the Bill. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 32 to 35 not moved.]

Clause 11 [Work-focused interviews]:

[Amendment No. 36 not moved.]

Lord Skelmersdale moved Amendment No. 37:

“( ) for the role of carers in work-focused interviews;”

The noble Lord said: My Lords, these probing amendments seek reassurances on the role of carers in ESA, which has barely been mentioned. After Committee, I received a letter highlighting this lack of debate and I am glad that this timely reminder means that I can seek some answers to this subject. The letter was from a carer receiving carer’s allowance for his work supporting a disabled person. He has been left entirely uninformed about what expectations would be placed on him should the person for whom he cares be placed in the work-related group and therefore become subject to conditionality.

We have established that a claimant may bring a supportive person, such as a carer, to an interview or an assessment, but where will that end? Will expenses be provided for a claimant to bring their carer? Will judgments be made on their capabilities on the assumption that their carer will always be present? If work-related activity is suggested on the ground that a carer will be present, what will happen if the carer finds himself—or, more likely, herself—unable to attend? Will the claimant be subject to sanctions if they are unable to achieve what is expected of them?

A carer’s benefits could be put at risk. If a claimant is judged able to take part in work-related activity without a carer present, the amount of time that a carer is judged as engaging in care may fall sufficiently for them to lose their allowance despite having little or no say in the work-related activity expected of the ESA claimant. This amendment is purely investigatory, but I beg to move.

Baroness Morgan of Drefelin: My Lords, the Government understand the wish to ensure proper support and advocacy for employment and support allowance customers. They acknowledged those concerns when introducing the Pathways to Work pilots. In their consultation response, the Government

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published safeguards that would apply in the pilot areas, which included encouraging advocacy support if needed and, in the context of home visits by Jobcentre Plus staff, suggesting that a representative should be present where appropriate. In many cases, a carer might well be the most appropriate person to be present, although we would not wish to exclude a customer from being accompanied by someone who would not necessarily be seen as a carer.

These measures have been put into practice in the Pathways areas. It is not unusual for incapacity benefit customers to be accompanied in interviews by support workers, helpers from voluntary organisations, partners or family members. It is fully accepted that that makes for a more constructive discussion on the part of the personal adviser and a more reassuring experience for the customer.

We are in no doubt that customers—and the success of their participation—will benefit from having someone to support them during work-related activity. We will make it clear to them and their representatives that they are very welcome to involve any suitable person to support them during their work-related activity. That person might be a carer. I can offer assurances that a carer’s allowance will not be affected by accompanying a customer to interviews and on work-related activity. Nor will it be affected if the customer is paid reasonable expenses, such as travel costs.

As I made clear earlier, the presence of intermediaries is firmly established as the normal procedure for conducting interviews. However, it would not be appropriate to place requirements either on customers or their carers to ensure that the customer was accompanied at interviews or while undertaking work-related activities. Nor is it necessary to spell out a specified role for carers in the Bill. I urge the noble Lord to withdraw his amendment.

Lord Skelmersdale: My Lords, seldom has a probe been quite so successful. That will satisfy my correspondent no end, especially the Minister’s remarks about what would and would not affect the claiming of carer’s allowance and the changes that this would make to it. I hope that that will be sufficient. I have pleasure in withdrawing the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 38 and 39 not moved.]

Baroness Thomas of Winchester moved Amendment No. 40:

The noble Baroness said: My Lords, the amendment is designed to prevent sanctions from being applied to people who need help rather than a penalty. In Grand Committee, we heard from the noble Lord, Lord Layard, who told us that people

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with treatable conditions need treatment. I was particularly shocked to discover that less than half the people who are mentally ill receive any treatment at all. In this day and age, it is incredible to think that those people are likely to be penalised under this Bill because they are not receiving appropriate treatment for their illness. I know that the Minister will not like the word “penalise”, because the withdrawal of the work-related activity component is, according to his brief, an,

I think that most people will regard it as some sort of punishment.

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