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I took his point in Grand Committee that his department supports the Department of Health programme on improving access to psychological therapies. However, I wonder whether enough people are being trained in evidence-based psychological therapies so that, as the Bill is rolled out in all areas, those therapies can be offered throughout the country. The figure of about £750 to train someone in cognitive behavioural therapy is, as the noble Lord, Lord Layard, said in Committee, the cost of incapacity benefit for one month. The more people who are qualified in this important branch of mental health, the better. I beg to move.
Baroness Meacher: My Lords, in supporting this amendment, I thank the Minister for our very helpful discussion. I believe that we are all of one mind in wanting evidence-based psychological therapies and good employment placement support to be available to people with mental health problems and others who would benefit significantly from such help. The overwhelming economic arguments in favour of government funding for those services were well rehearsed in Committee and we do not need to repeat them. We also understand the challenge for the DWP in pressing the Department of Health to ensure that it plays its part in maximising the success of the welfare reform policy.
Nevertheless, this amendment would be a valuable lever at local level to generate pressure from Jobcentre Plus on primary care trusts and mental health trusts, such as my own, to provide high-quality CBT and job placement services, which they should be providing to honour the Governments manifesto and their social inclusion commitments. However, we know that mental health is always a Cinderella service that picks up the morsels left under the table once the demands of cancer, heart, paediatric and A&E services have been met.
The logic is overwhelming. If the Government succeed in reducing by 1 million the number of people dependent on employment and support allowance, that will save billions, some of which could no doubt be spent on acute medical services. If the Government do not make the investment in the first place, they will be shooting themselves in the foot. We know from all the research studies that 50 per cent of people with depression and anxietythe majority of the half of incapacity benefit claimantswho receive evidence-based cognitive behavioural therapy will recover. As the noble Baroness, Lady Thomas, has suggested, the case for spending £750 per person is irrefutable.
How would the amendment achieve the Governments objective? If Jobcentre Plus could not apply sanctions at any stage of the process to a claimant assessed as needing CBT or other interventions that would enable them to become capable of work, surely it would enter into negotiations with its local PCT and mental health trust to ensure that the relevant therapies were provided. That detail cannot be included in the Bill.
Therefore, without wishing to ask too much, I hope that the Minister will support this amendment. I also hope that he will assure us, first, that regulations will specify that the work-focused health-related assessment will include questions designed to identify whether each claimant suffers from depression, anxiety or another diagnosed mental health problem; secondly, that the assessment will specify whether the claimant has received CBT and, if not, recommend that it should be offered; and, thirdly, that the assessment will identify those claimants with mental health problems who should be referred for individual job placement and support. That term refers to specific evidence-based support in identifying suitable jobs and preparing for interview, and support through the process of returning to work.
I would be happy to make available to the Minister the research evidence showing the cost-effectiveness of that approach. The answers to questions (a) to (c) would trigger the protection from sanctions until the evidence-based psychological therapy or other support had been made available to the claimant. Anyone not familiar with mental health problems could regard such safeguards as excessive. I suggest that the results of the Pathways pilots underline the need for evidence-based interventions with the 50 per cent of claimants who suffer from mental health problems, if the Governments welfare reform policy is to be a success. I hope that the Minister will be able to support the amendment.
Lord McKenzie of Luton: My Lords, first, I acknowledge the genuine concern that some noble Lords have about how this will work, particularly for people with mental health problems. I know that noble Lords table amendments with the very best of motives. I regret that I am not able to accept the amendment, but I hope that I can explain why. I understand the intention and we share the objective of wanting to make this work for all customers, especially those with mental health conditions.
The work-focused health-related assessment is a tool to allow the personal adviser and the customer to understand what barriers a customer faces in returning to work. For most customers, it will cover a range of barriers, although, as we have said previously, the focus will be on the customers own perceptions of the barriers resulting from their disabling condition and on identifying any health-related barriers that could be addressed with appropriate interventions. The work-focused health-related assessment will not prescribe what a customer must do. It will provide advice to the personal adviser carrying out work-focused interviews
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For instance, a work-focused health-related assessment will not say to someone that they must undertake any type of treatment, including cognitive behaviour therapy. The work-focused health-related assessment does not produce a tick list of things that a customer can do that will mean that they can return to work. Instead, the assessment provides information to our advisers, who can then treat customers as individuals. Each individual will have their own journey. We know that some with severe conditions will want to, and can, move into work quickly. For others, it is a longer journey, and our approach recognises that.
It is entirely right that we offer support to customers to overcome their barriers. That was the groundbreaking innovation of Pathways to Work. The Pathways offer was, and continues to be, based on customers engaging with us in return for support to help them to move back into work. We know that Pathways has changed many, many lives for the better. That is reflected by double the job entries in Pathways areas compared to non-Pathways areas. It is also seen through the one-to-one research that has shown that the support on offer is welcomed by customers and has helped them to overcome their barriers, even when work has not been a realistic option for them. At the heart of that is the fact that we have required customers to engage and that there are sanctions for the very small minority who do not. I stress that the required engagement in Pathways, and initially when ESA is introduced, is to attend up to six work-focused interviews. We encourage any activity beyond that, but it is on a purely voluntary basis. The system that required nothing of customers and gave nothing in return failed. It failed in terms of the numbers on incapacity benefit and in the lack of support for the aspirations of our customers.
We have said that we want to go further in the future with the new benefit. We want to offer more information to the customer and to the personal adviser through the work-focused health-related assessment, and we want customers to engage in mandatory work-related activity in time. However, we have also said that work-related activity will be made mandatory only when we have the resources to do that. To be explicit, those resources will be needed to expand the provision of help and support. We have also made it clear that we will build this offer of help and support on the evidence from Pathways, including those provider-led areas that will be rolled out over the next couple of years.
When we require customers to engage with that support through mandatory work-related activity, we have been very deliberate to allow customers a wide choice of what they can do. The definition in Clause 12(7) makes it clear that anything that improves the customers chances of obtaining or retaining work will count as work-related activity. That is in line with our approach of treating customers as individuals.
Baroness Thomas of Winchester: My Lords, if the work-focused health-related assessment uncovers the need for some intervention in the mental health field, is there nothing that the doctor can do? Can he suggest anything to a personal adviser? Can the personal adviser do anything? No one can suggest to the claimant that this would help them into work. I wonder whether that could happen.
Lord McKenzie of Luton: My Lords, I understand the thrust of the point. No one is saying that if the work-focused health-related assessment identifies a course of treatment that might be beneficial for the individual, that is going to be ignored. Various things might flow from it. The GP would see the result of the assessment, with the agreement of the customer, and so could take steps to see what was available from the local PCT. It is possible, as resources allow and as we move further into work-related activity, that the provider may provide a course of treatment that deals with the item identified. It will not be ignored. The provider would not and is not being asked to guarantee that every recommendation or every point that is noted from that assessment would necessarily lead to specific health-related action. That is not the primary purpose of the assessment; but it is not to ignore it.
The point that I am seeking to stress relates to whether anything in the assessment would lead to sanctions. What would generate sanctions at the moment, at this stage, is non-participation in the work-focused health-related interviews. In due course, when work-related activity is introduced, there could be sanctions attached to that. We do not anticipate that the work-focused health-related assessment will lead to a whole range of specific actions required of the customer that could lead to sanctions.
I hope that that has helped the noble Baroness. I am happy to come back on it. I stress that we cannot force customers to undertake medical treatment; that would be wholly wrong. What comes from the assessment is building part of the evidence, in particular the discussion with the customer about how they see their condition impacting on their ability to move back to work.
We recognise the need to be sensitive to the individuals circumstances when we require them to participate in interviews or activities. That is why, in Committee, I outlined the safeguards and flexibilities in the system to respond to the needs of all customers, particularly those with mental health conditions. I do not wish to go over those in full, but I reiterate that they include contacting customers to remind them of interviews or assessments, encouraging advocacy advice where necessary, and identifying any issues from medical evidence that may impact on attendance. Additionally, where a customer has a mental health condition or a learning disability, a visit is made to a customer, with their representative if appropriate, if a sanction is to be imposed. Personal advisers will also be able to defer a requirement to take part in a work-focused interview where that is appropriate in the circumstances, and that decision can be made in advance of the date of the interview.
The help and support coupled with the responsibilities that we are rolling out through Pathways to Work and in relation to this Bill are groundbreaking. From the research that we have done, we know that this has been welcomed by our customers. I challenge the assertion that Pathways does not work for those with mental health conditions. The issues surrounding the early IFS research have been debated at length in Committee. However, that is only one element of the research looking at employment. In fact, research with individuals has shown some remarkable journeys for customers with mental health conditions. These have not always resulted in employment, yet the positive effects on customers who would never have been supported in the past are clear. Those are exactly the kind of journeys that we should support. I urge noble Lords, where possible, to visit their local Pathways to Work, to experience the real differences that support on offer is making. My office would be more than happy to make arrangements for noble Lords who wish to do that.
In conclusion, I state again that there is considerable flexibility and protection in the system. We will roll out further provision of work-related activity, beyond what exists in Pathways to Work, before introducing mandatory work-related activity. The work-focused health-related assessment will be a tool to help the customer to understand and overcome his barriers. However, it is not a tick list and customers will rightly have the freedom to choose the type of support that is right for them. I hope that that has reassured, although I suspect not completely, the noble Baroness. I urge her to withdraw her amendment.
Baroness Thomas of Winchester: My Lords, I thank the Minister for his further explanation. Will he leave the channels of dialogue open to experts, such as the noble Baroness, Lady Meacher, in this very sensitive area before regulations are brought in, so that we can have the best possible result for people with mental health conditions?
Lord McKenzie of Luton: My Lords, we are very keen to continue dialogue on these matters. Much work is taking place, particularly in relation to CBT. There are the pilots that we debated before; the report commissioned by the Chancellor is due to be announced very soon; and work will rightly continue with stakeholders. On the specific regulations on the provisions in the Bill, which are moveable, we have to make progress. This is a hugely important area. The debate that we have had on the Bill and elsewhere has helped to raise the profile of some of the issues and it is very important that that debate continues.
The noble Lord said: My Lords, the way in which the Bill is drafted has caused no little confusion among my adviserspossibly the Minister too, judging from that laugh. Clause 15 allows the final decision on whether a claimant is to have his benefit reduced for non-compliance with the obligations to be attached to the payment of ESA, examples of which might be not turning up to an interview at the jobcentre or not seeing his personal adviser when he should. That could be done by any contractor; for example, a personal adviser or a health professional. Ministers have said that they have no plans at present to do that. However, I put it to the House that they should never let go of the ability either to pay or to withdraw social security benefits. These amendments, therefore, seek to remove any possibility that the Government will contract out the power to impose a sanction on a claimant or to make the final decision relating to whether he has fulfilled the conditionality requirements.
I have already spoken of my concern about this in Committee and privately to the Minister. He has left me with the impression that even the Government are 100 per cent uncertain about contracting out those powers being the way to go. He is smiling again; he must be agreeing with me, for a change. It is equally clear that many representative organisations are as unhappy as I am. Therefore, I hope I may convince him that whatever the benefits that may accrue from contracting out some of the functions relating to the payment of ESA, the power to withdraw benefits should remain with the organisation that pays the benefits; namely, the Government. Any other situation runs the risk not only of subjecting claimants to a postcode lottery as regards the severity of the sanctions that they risk, because different contractors will operate in different parts of the country, but of the Government losing control of a vital tool in the achievement of their aim to reduce the numbers of disabled people unable to find or to keep employment.
No matter how watertight the contracts are with the private or non-governmental organisations, some diversity will grow up as each organisation interprets the guidance and the requirements differently. The dangers of contracting out sanctions have been noted elsewhere. David Freuds recent report for the DWP states that sanctions should be administered through Jobcentre Plus, thus ensuring that the state remains responsible for those collecting benefits as a way of maintaining the significance of the sanction.
Many organisations that intend to bid for the contracts when they are offered are also unwilling to take on the responsibility of imposing sanctions. Support for the amendment comes from Mencap, Rethink, the RNIB, Leonard Cheshire, the NAS and Action for Blind People. The list is long and illustrious. They feel not only that this will risk
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Lord Oakeshott of Seagrove Bay: My Lords, we on these Benches stand shoulder to shoulder with the official Opposition. Our names are to these amendments. There must be no privatisation of benefit cuts. We oppose the Governments provisions in principle. The Joint Committee on Human Rights stated very powerfully:
We remain concerned that, generally, contract compliance will not provide effective protection for the Convention rights of individuals where the functions of public authorities are assumed on a day-to-day basis by a private commercial or voluntary organisation. We draw this matter to the attention of both Houses.
The Government said in the other place and here in Committee that they have no current plans to do that, but they are fighting to the death to keep that option and to do it by regulation, when we shall not be able to amend it. In a Bill such as this, one has to state very clearly whether one will do that. We are completely against it; we believe that to give others that power would be an unacceptable abdication of responsibility by the state towards some of its most vulnerable citizens. We support the amendment wholeheartedly.
Lord McKenzie of Luton: My Lords, I thank noble Lords for setting out their concerns. By this stage, we are all familiar with the arguments that have been made for and against the contracting-out of decision-making that could lead to sanctions under Clause 15. However, I do not think that enough attention has been paid to the potential benefits of moving decision-making of this kind closer to the organisations that deal with customers on a day-to-day basis. I do not believe that these benefits can be dismissed; they should get the measured consideration that has been the hallmark of the debate surrounding the Bill.
Decision-makers make their best decisions when they have the proper, accurate and timely information needed. There should be no argument about that. There is a real desire among noble Lords and stakeholders that decision-making be improved and decisions be right first time. Locating decision-makers within provider organisations could make the process of information-gathering faster, easier and more accurate. Having two different organisations, one responsible for support and the other for conditionality, also weakens the link between the support that customers receive and their responsibility to engage with us.
Responsibility is not an added extra to ESA that should be dealt with separatelyfar from it. It is an integral part of ESA. For sanctions to be a proper incentive, customers must realise that there is a
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There are potentially a number of benefits of contracting out decision-making leading to sanctions. Given the strength of feeling on this issue and the questions yet to be answered, we acknowledge that we need do more work with stakeholders and providers in this area. We will not seek to retain the powers in the Bill to enable us to contract out decision-making that could lead to sanctions.
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