Welfare Reform Bill

My Lords, I shall address my comments to the Bill’s mental health aspects. They have already been well addressed by other noble Lords, so I can cut down considerably on what I was going to say; many of the facts and figures have been ably addressed by the noble Lord, Lord Low, and others. Paid work gives people with mental health problems tangible evidence of their own value, improves self-esteem and can give them a sense of mastery over their lives. I welcome the Bill, in building on the Pathways to Work pilots, while pointing out that early evidence suggests that people with a mental illness have been less successfully helped back into work than those with physical health problems. The Bill raises some practical issues. As the noble Lord, Lord Morris of Handsworth, has just said, one of the Bill’s problems is that the devil will be in the detail of the regulations. I may therefore be raising issues to be addressed in regulations; if so, I hope that the Minister will bear with me for the moment. The accuracy and appropriateness of the revised personal capability assessment (PCA) is clearly crucial. The revised version is a big improvement for people with mental health and learning disabilities. However, we know that, when implemented across many hundreds of thousands of people, the sensitivity and skill with which these assessments are carried out might in practice be less than perfect. We must ensure that staff are better trained to understand fluctuations in mental state, difficulties in social interaction and the importance of taking time. As mentioned by the noble Baroness, Lady Hollis, staff often want support and have a good approach to it, but not the knowledge or skill to apply it properly. The personal capability assessments can therefore be applied incorrectly. Given the pivotal role played by the PCA and the concerns about the review process, I add my voice to those who believe that there should be long-term government monitoring of the new PCA. When conducting the PCA, medical assessors from Atos Origin are guided through the issues to be covered by the computerised questionnaire known as LiMA (logic integrated medical assessment), which the noble Baroness, Lady Thomas, described so accurately in her vignette. As they go through an assessment, the doctor records claimants’ responses by selecting pre-coded options suggested by the LiMA system. In the main, the final assessment report is made up of a series of selected pre-coded responses. I am perhaps referring to a period before Atos Origin took over this contract, but given the lamentable knowledge and skills about mental health issues frequently demonstrated by medical assessors, we might be better off trusting a computer program. However, for accuracy it unfortunately still requires high-quality input and sensitivity from the doctor. On average, the process takes 45 minutes and is completed in a one-off snap-shot assessment. What must be addressed is the quality of decisions currently being made. It is interesting that, in spite of the promised objectivity of these ““mouse-driven medicals”” as they are called, appeal after appeal—over 70 per cent—still says ““No”” to computer-generated reports and ““Yes”” to the claimant. Something is not right here. How we implement this may be important. Requests for access to LiMA have been turned down, I understand, because it is exempt from disclosure under freedom of information legislation, as that might threaten the commercial interests of Atos Origin. It seems extraordinary that such an important tool should not be available for parliamentary or public scrutiny. Can that be correct? I was surprised to be informed of this by organisations. Can the Minister confirm why we cannot scrutinise it and judge whether it is an appropriate tool? At present, the great majority of appeals against decisions are successful, indicating that gate-keeping is poor. There should be regular customer surveys about the PCA process to ensure that it is fair, credible and can be continuously improved. Under the current system, many people find themselves subject to a PCA once they begin to take steps to work, such as volunteering or educational activity. For people on the support component of ESA in particular, fear of an untimely PCA could become a barrier to participation in such activities, leaving them in the benefits trap. The regulations will provide an opportunity to stipulate when and in what circumstances a PCA can occur. That would give people on ESA greater trust in the system and more security to take the necessary steps towards employment. I recognise that, in Pathways to Work areas, many personal advisers ensure that customers taking steps to work are not penalised by an unexpected PCA. The regulations should ensure that this becomes standard practice in all areas. Individuals applying for employment and support allowance will be required, as we have heard, to undergo both a PCA and a work-focused, health-related assessment at the same time or sequentially, with a doctor who is not necessarily qualified to assess work capabilities and rehabilitation needs. That is a serious concern. The PCA is a means of determining whether a person is eligible for one or other component of the benefit, while the WFHA is a further test of, "““the extent to which a person still has capability for work””," and whether it, "““may be improved by the taking of steps in relation to his physical or mental condition””." Combining the two assessments risks confusing both the assessor and the claimants, and could sow mistrust between claimants and their personal advisers. Health professionals trained to determine a person’s ability to work or undertake work-related activity are not necessarily best placed to assess a person’s vocational rehabilitation training needs. We need to learn more about how people will be trained to administer these two related assessments; it is by no means clear. The Bill goes further than the Green Paper in extending the use of sanctions. They have been extended to cover attending a work-focused, health-related assessment and undertaking work-related activity. There is no evidence that sanctions are necessary to achieve the welfare reform objectives, and it is not clear why the use of sanctions has been extended and how they will work in practice. For people with a serious mental illness, further sanctions would add a fear factor in the system which will be counterproductive. I do not believe that it is desirable for sanctions to be extended to cover health-related assessment and work-related activity, nor am I confidant that the skills and knowledge of DWP staff can ensure that sanctions are fairly applied. However rarely they may be applied in practice, in reality everyone will know about them and have an instinctive fear of them. People with a mental illness usually want to work, and it is a tragedy that three-quarters of all adults with schizophrenia in this country have no employment; indeed, many employers say that they would not employ them under any circumstances. Yet, we know that no adaptations have to be made to employ patients who suffer from schizophrenia and that many such people are employed and have useful and constructive lives which, with support, many more could enjoy. If the reforms do not work for people with serious mental illness, the policy will fail. I look forward to hearing more on the Government’s plans for implementing these reforms, through the regulations, for the benefit of people with mental health problems.