Disability Assessment Services -Westminster Hall

I beg to move,

That this House has considered improvements to disability assessment services.

It is an honour to serve under your chairmanship, Sir Christopher. I am grateful to have the opportunity to debate this important topic. People with disabilities and ill health are often confronted with barriers at every turn. I believe it is the role of Government to remove these barriers as often as possible. Everyone deserves the same opportunities to achieve their potential, and I am proud that we are ensuring that the issue is high on the Government’s agenda. The support available through the benefits system is there to take some of the strain off people who are living through often unimaginable day-to-day challenges. However, I am sure that, like me, colleagues have heard from constituents at times when they have needed help and found it difficult to navigate the system.

A very dear friend of mine and colleague from the business world, Andrew Knowlman, sadly lost his courageous fight with motor neurone disease late last year. He used his time and experience of the disease to campaign to ensure that I clearly understood the physical challenges it brought him, and the challenges he faced in trying to access the support available through the Department for Work and Pensions. One of the most significant issues that he brought to my attention was the repeated requests he received to attend work capability assessments.

This point is echoed by my constituent Lee Millard, who has been diagnosed with the same condition. Lee and his wife Jean have been campaigning to make a difference for those affected by the disease. When we met, Lee explained how stressful the reassessment process can be for claimants of the employment and support allowance, which is now moving across to universal credit, and personal independence payments—particularly when we consider that conditions such as motor neurone disease are degenerative, and the person who is affected is all too aware that they will not improve. He said that the whole process can feel very much like a “waste of precious time.”

Intervention - Andrea Jenkyns

Does my hon. Friend agree that disability assessors should rely more on the opinion of medical experts, particularly when judging mental health and invisible disabilities?

 

Yes, that is absolutely vital. One of the learnings from the system is that it needs to make sure that those assessments are available in time. I will go on to talk about that.

In a bid to tackle this problem, the Department stopped requiring people with the most severe and lifelong conditions to undertake assessments from September 2017. However, some of my constituents told me that that is not their experience, and that they are still being asked to go for assessments. The Minister kindly clarified that for those receiving ESA and universal credit before 29 September 2017, the severe conditions criteria will take effect at their next work capability assessment, so it could be that my constituents had one after that date, but will not have another.​

I welcome the move, which is being encouraged, to enable decisions to be made without face-to-face assessments, through health questionnaires and evidence collected from GPs and specialist health professionals. On a similar note, I am pleased that people receiving the highest level of PIP will receive an ongoing award, with only a light-touch review after 10 years. That is another progressive step to ensure that those who most need support receive it hassle-free.

Intervention - Vicky Ford

Some of my constituents have found the PIP assessment process and the work capability assessment deeply traumatic and very flustering, and they often get confused. Does my hon. Friend agree that allowing assessments to be recorded—especially video-recorded—will give people confidence that they are getting a fair assessment, and that the assessors are being monitored and must come up to a high standard?

 

Yes, I do. Technology in general is enabling us to put better processes in place. Recording will not be appropriate for some people, but it is important to use technology in the right circumstances.

Intervention - Jamie Stone

I declare an interest: my wife is disabled. I am interested in the assessment that takes place when somebody moves from the disability living allowance to PIP. From my constituency surgeries, I have noticed that that the mobility element for DLA is somewhat lower than for PIP. Does the hon. Lady think that that pattern is more widespread throughout the UK? Is there something here that is not right? Leaving out my wife, I have dealt with cases of people who have lost out on the initial assessment. The sentiment about continuing assessment is absolutely correct, and I support that.

 

I am not in a position to see an overall pattern—perhaps the Minister does, because she sees what is going on across the country—but many of us have heard about issues relating to mobility and Motability.

Last week, the Secretary of State announced that people over state pension age will no longer have to go through PIP reassessments. That is part of her ambition to ensure that disabled claimants do not feel like they are on trial. These changes have been rightly welcomed in the press and, I am sure, by many Members in this Chamber.

These improvements are good news for claimants. However, one of the most common times when I receive a request for help from a constituent claiming disability benefits is when they do not agree with the outcome of their assessment. Recent figures from my area—Chichester—show that the overturn rates at tribunal are 71% and 81% for ESA and PIP respectively. It is my understanding that that is largely due to medical evidence not being available in good time, and being available only at tribunal. Those levels are clearly unacceptable. It is very stressful for people to go through the initial assessments, the reassessments and a tribunal. I would be grateful if the Minister could let us know what more work is being done to improve the system. Are there any plans to consider the timescales within which we ask GPs and medical professionals to give information about claimants, to ensure it is in time for assessments?

Intervention - Justin Madders

We have all seen that the appeal rates are unusually high. What, in the hon. Lady’s experience, is the time it takes to get to an appeal? In my part of the world, it is 40-plus weeks, which for some of these people is a ridiculous amount of time to wait.

 

Yes, it can be quite a long time. We have heard that people can wait for three or four months. That uncertainty means that it is very difficult for a person to plan, as they do not know how much support they will receive.

Intervention - Ruth George

The hon. Lady is making an excellent speech and is putting into words what a lot of us experience in our constituencies. In my area, it takes 48 weeks for an appeal to be heard, and people usually have to sign on for universal credit, rather than ESA. They have to undergo conditionality, even though in 71% or 72% of cases in my area, at the end of the process it is found that they are not able to work. They are being pushed into that by a system that does not take into account their disability. Does the hon. Lady agree that that desperately needs looking at? People have to wait a year or more to get assessed properly.

 

Yes, I do, but we need to solve the root cause of the problem, so that we do not have these high tribunal rates. If we do not have them, we will not have the waiting times. That is the best way to ensure that the system has a low failure rate.

Intervention - Debbie Abrahams

I am very grateful to the hon. Lady for giving way. She is being very generous with her time. Is she as concerned as me about a report in the GP journal Pulse last week that said that the transformation of the new health assessment system could lead to unfettered access to medical records via the GP? We should surely speak up against that. Medical records are personal data; that is an absolute human right.

 

Yes, although we need to balance that with having enough medical data to make the assessments in the first place. I have not seen that report. I do not know whether the Minister has, and whether she can take that into account in her speech.

I am glad to hear that, following the recent Government announcements, we are moving our benefits system into the 20th century by integrating multiple data sets into one system, although I take the hon. Lady’s point that we must ensure that they are very well protected. That will streamline the assessment process and make submitting a claim much more user-friendly, particularly for people transitioning between benefits. Plans to test a single health assessment for all disability benefits will mean less form-filling, and will reduce face-to-face assessments, cutting red tape and the inconvenience it causes. My constituents who need support often have highly complex needs, so I hope the changes will save them time and stress. It is important that we listen to our constituents and put them in the driving seat of reforms. I hope the Department will do that.

An issue that has been highlighted to me is people’s reluctance to attend assessments. We must do more to ensure people feel comfortable with and trust the process. ​It is key that we ensure that people know that in every case they are being assessed by a qualified doctor, nurse or healthcare professional—often somebody who works in the NHS—who has undergone additional training to carry out assessments. I did not realise that every single assessment is carried out by a qualified medical assessor. Many members of the public do not realise that. They think it is some third-party company, but often nurses work for those companies. We need to do more to make sure that people are aware of that, so they feel more comfort and trust.

Intervention - Kirstene Hair

Does my hon. Friend agree that we must ensure that the questions in the assessment process are not too intrusive, so people do not feel that their integrity or dignity has been taken away from them? They should feel comfortable taking part in the process.

 

Yes, absolutely. We should not only look at who is carrying out the assessments, but open up where they can take place. Perhaps we can have a wider range of premises where assessments can be carried out, including places that are more familiar to and convenient for claimants, such as local authority buildings, NHS sites or even jobcentres. I would be interested to hear whether the Minister has any plans to do that.

In recent years, disability employment has risen, and now over half of disabled people are in work. Nine per cent. more disabled women and over 6% more disabled men are in work than in 2013. That is testament to the programmes that support people with disabilities into the workplace. I am pleased to hear that the Secretary of State outlined her ambition to build on that record, as every person with a disability or learning difficulty deserves the same opportunities to go to work and build a career. Programmes such as the personal support package have been crucial to that; they provide tailored employment support that recognises the individuality of people’s conditions. Much of that work is done through the jobcentre. In Chichester, we have a great team with some real success stories because of the support available through the programme.

Our Jobcentre Plus makes good use of the community partners and small employment advisers. Chichester has a low unemployment rate of 1.7%, so local businesses look to use all the available talent and need more local people in the workplace. I am glad that the small employment advisers are able to bring people with long-term health conditions and disabilities together with businesses to help them find a decent job.

Work coaches and disability employment advisers use all the tools at their disposal to help build skills, and to help disabled claimants prepare for the workplace. They do that not only through national programmes, such as the Work and Health programme, but local initiatives, such as WorkAid, which is run by the Aldingbourne Trust. It is great to hear the success stories of constituents who have managed to move into work, and that is made possible by the tireless effort of the jobcentre staff, who make those initiatives a success on the ground. I am sure that we all have many examples of that.

Getting a good job has a powerful impact. Last year, I met a constituent whose son is on the autism spectrum—there is a big problem getting people with autism into the ​workplace; much more needs to be done on that. She told me that he rarely utters a word and is uncomfortable around people. She is determined to help her son, and managed to get him work experience at a games software development firm. That was transformative; for the first time in a long time, he began to speak.

Getting a foot on the career ladder is challenging irrespective of disability; sometimes, extra-special effort must be made to find opportunities, particularly for work experience. I am very pleased that the jobcentre is offering careers advice to disabled students in schools, because building confidence in disabled kids as early as when they are 12 is critical to making them feel that they have all the opportunities that everybody else has. This is just the start; there are exciting pilots up and down the country, such as Tri-Work, which offers work experience to children in years 10 and 11, and programmes that support internships for school-leavers. I want every disabled child to be excited and have a wide range of options in the workplace, so we need to ensure that such initiatives are available throughout the country. The schemes are empowering young children, but they must to be available to all who need them.

The Disability Confident scheme is another successful programme, which now has almost 10,000 signatories. One participating employer is Chichester District Council, which works hard to make sure that its work environment is accessible, and has made workplace adjustments—for example, providing ramps, lifts, and an emergency evacuation chair. Perhaps more importantly, on top of that, the council has a welcoming workplace culture, actively helps applicants to apply, and will always interview disabled applicants when they have fulfilled the basic role requirements. That additional support removes the barriers to the workplace for disabled people and gives them confidence to start their journeys into new jobs.

We all know from our constituents that the system is not perfect, but I am pleased that the Government and the Secretary of State are listening to constituents’ voices and reforming it. There needs to be less stress, wasted time, and red tape all round; we need a more welcoming environment that makes people feel that they can trust the system, not that they are on trial.

I am proud of this Government’s record in supporting disabled people into work. There is still a long road ahead to ensure that all disabled people who can and want to work get the support that they need and the opportunities that they deserve.

Ministerial Response - Sarah Newton - Minister for Disabled People, Health and Work

It is a pleasure to serve under your chairmanship, Sir Christopher. I am grateful for the number of Members from across the House and all parts of the country who have come together for the debate. There is a compelling debate going on in the main Chamber, yet many Members chose to prioritise this debate, which is to the great credit of everybody who has participated.

I pay particular tribute to my hon. Friend the Member for Chichester (Gillian Keegan) for her passionate, eloquent and well-informed contribution. She was joined by many colleagues who shared examples of the poor treatment that their constituents had faced in going through the ​assessment services. That is exactly why we made the announcements last week about the transformation of the way that we undertake assessments.

Our approach has been one of wholesale continuous improvement—to the personal independence payment since it was introduced, but also to the work capability assessment, since it was introduced by the Labour Government back in 2008. There have been numerous independent reviews, the Select Committee did an excellent inquiry and the Department has embraced and implemented a great number of recommendations. We are committed to continuous improvement, as the hon. Member for Ellesmere Port and Neston (Justin Madders) asked us to be. I thoroughly agree with him and want to reiterate what he said: we should treat others as we would like to be treated. Everyone should be treated with respect and dignity, and I can assure him and my hon. Friend the Member for Chichester, who also raised that point, that there is no complacency at all; there is an utter commitment to improvement.

It is great that we often have debates in this Chamber on this subject. I am sure there will be other opportunities to ask questions, perhaps in oral questions to the DWP on Monday.

My hon. Friend the Member for Chichester asked some questions that I particularly want to answer. She made a good point about how people feel when they go to an assessment, as well as about the location, how people look and what clothes they wear. People forget that the assessors are fully qualified healthcare professionals; they are the same people they might see if they went to A&E on a Saturday night. As part of our transformed service, we are looking carefully at where we can co-locate services. That could be in NHS or local authority facilities, but they need to be in a place where people will feel more comfortable.

We are seriously looking at how the people undertaking the assessments appear, and at ensuring that their certificates showing that they are fully qualified healthcare professionals are available, so that people have the same confidence when going to their assessment as they do when going to see their GP. Most people have a high degree of trust in their GP, and that is helpful, because that is the point that I want to get to. Repeatedly, GPs and healthcare professionals have told us that they do not want to be the gatekeepers of the benefits system, as that would get in the way of their patient-doctor, or patient-healthcare professional, relationship. We will need to have healthcare professionals undertake assessments, but they need to be separate from NHS services.

We are working closely with the medical profession to make sure that we have as close a relationship as possible, and to obtain information as swiftly as possible. I want to offer reassurance to the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) about how we will go about getting medical information in our new transformed service. It will be with patient consent. We will not break into NHS or GP computer systems and extract data somehow. The information will be obtained with the consent of the patient.​

I want to reiterate a commitment that I made at the Dispatch Box, when I answered the urgent question about the new transformed service. I want to make sure that disabled people co-design the service with us. We are starting soon on stakeholder engagement to enable that. We will work with the medical professionals—as I said, we will do a lot of work with them over the summer on this—stakeholders and disabled people. We want to improve people’s confidence and trust in the system, and make it properly accessible.

There were a whole range of really good points raised by the hon. Members for Strangford (Jim Shannon), for High Peak (Ruth George), for North Ayrshire and Arran (Patricia Gibson) and for Lanark and Hamilton East (Angela Crawley), and my hon. Friend the Member for St Ives (Derek Thomas), pointing to changes that they would like to see in the training of the healthcare professionals undertaking the assessments. I reassure hon. Members that a whole series of stakeholders—charities or people who work alongside those with particular health conditions—have met those undertaking health assessments to ensure that the guidance given to them is up to date and properly takes into consideration variability in conditions, and to ensure that those assessing people with rare conditions that we do not often come across are aware of that condition and its impact on a person’s ability to live their daily life in the way that we would like them to.

I assure all hon. Members that we give physical and mental health parity of esteem. Many of our healthcare assessors, as well as our frontline staff in the DWP, are undergoing good mental health awareness training, and they all have access to specialists whom they can call on. Through lots of small improvement to assessments, we are beginning to see real changes.

We spend a lot of time working with our colleagues in the Ministry of Justice to ensure that people can access tribunals in a more timely way. The delays are unacceptable. There has been recruitment of a lot of staff, and there is a new online resolution service for PIP, which was piloted and received good feedback from claimants. It will not replace people’s opportunity to have a face-to-face tribunal service, but some people might choose to go that way.

We are looking at improving our mandatory reconsideration process. It is not fair to say that it is a rubber-stamping process—around 20% of decisions are changed at mandatory reconsideration—but we are learning from the work we are doing with Her Majesty’s Courts and Tribunals Service to ensure that we can get more information, including medical information, from the claimant at the mandatory reconsideration stage, so that more decisions can be changed then, without having to go on to appeals.

However, the most important thing is to get more decisions right the first time, and to enable conversation, so that people are confident enough to give us all the information we need when we need it, and that we get that. We are working on that at pace.

In terms of the transformed service, it has been necessary to extend the existing contracts for both PIP and the work capability assessment, so that we have a ​secure and stable way of assessing the benefits. Developing the new transformed service will take a huge amount of work. We are creating a new digital platform, which we will co-design with disabled people. It will take this year to get that right; only then can we start to introduce the new service.

In the short time I have left, I return to the good point that my hon. Friend the Member for St Ives made about organisations such as the Benefits Resolutions service, formerly known as Bufferzone. I would love to work with him on what we can do to regulate those offering support to people going through the tribunal service. I agree with him; what he described is totally unacceptable. I would also like to work with my hon. Friend the Member for East Renfrewshire (Paul Masterton) and look at the report he mentioned to see what we can do to ensure that improvements are made.

I thank all hon. Members very much indeed; I am absolutely determined, as they all are, to improve these services and ensure that they are the best they can be.

Gillian Keegan - closing remarks

I thank the Minister very much, mostly for listening and taking into account all the points raised today. I thank you, Chair, for your excellent chairmanship, which got us through this debate in an hour, and I thank all hon. Members for their participation. It is clear that we all have similar desires and concerns: we want to ensure that the system continuously improves, treats people with respect and in the way that we would all like to be treated, and, perhaps most importantly, helps people to live a fulfilling life, so that they can make the most of their many talents. I thank everyone for participating, and I look forward to seeing the transformation of the service.