Welfare Reform Bill

The point about geography is essential. The drive behind these developments is to focus on the right of all people to benefit from employment. We know that in particular parts of the country, long-term economic inactivity is leading to appalling deprivation for families and single people, and it is essential that we address this. When my noble friend and I visited the Basildon Pathways to Work pilot, issues of how far we can roll out the positive experiences of a pilot nationally were at the forefront of our mind. One of the Pathways to Work pilots is in Rhondda Cynon Taf, which can hardly be described as an affluent area. There is a lot of learning to be done, and that learning is seen as very important. The department is not rushing to roll this out across the country without taking into account the huge variation in distribution of need. It is a fundamental principle of any benefit entitlement decision that it should be applied consistently across the country. It would not be appropriate for entitlement to ESA to be based on standards that vary in different areas of the country, rather than being based on the condition of the individual customer. The PCA already addresses the requirements of consistency in a number of ways. First, it is based on defined criteria by which limited capability for work is assessed—the descriptors and scores in the draft regulations. These descriptors focus on whether a person's condition has resulted in him having limited capability for work, not on whether he has a named condition. Different people may have different levels of functional limitation arising from the same disabling condition. The approach that we have taken with the PCA descriptors avoids this problem by assessing limited capability for work in a consistent and objective way against the same set of descriptors, regardless of where the assessment is carried out or by whom. Secondly, healthcare professionals carrying out the medical examination that forms part of the PCA are trained to standards prescribed by the department's chief medical adviser before they are approved by the Secretary of State to carry out the medical examinations. They must subsequently maintain those standards to keep that approval. The quality of their reports and the advice they give to the decision-maker on the basis of paper evidence is monitored on a regular basis, again measured against clearly defined standards prescribed by the chief medical adviser for the Department for Work and Pensions. These standards are used in all medical services centres; and their use will be regularly audited to ensure that they are being applied consistently. We will continue to take these measures in relation to the revised PCA to ensure that it maintains this consistent approach when it is applied for the purposes of the ESA, both for the tests of limited capability for work, dealt with in Clause 8, and limited capability for work-related activity, dealt with in Clause 9. There were further questions about the decision-maker. Formally, the Secretary of State delegates decisions to the decision-maker, who takes all the information provided by the assessment process and formally makes the decision for benefit entitlement. I hope that that answers that question. I was asked what we were doing about monitoring the quality of medical reports. Sub-standard reports are a minority and I am pleased to say that Atos Origin Medical Services, which carries out the assessments, regularly monitors a statistically valid sample of reports that come out of this assessment and fewer than 5 per cent of them are unsatisfactory. Atos Origin has a programme of continuous quality improvement, which its audit results demonstrate is effective in driving up standards. Doctors who fail to meet standards are given feedback and remedial training. Their work continues to be closely monitored until they have reached the required standard. Importantly, if they fail to reach the standard despite retraining, their approval to carry out the assessments is revoked. I do not believe that making provision in legislation for the PCA to be applied consistently would enhance or improve the systems already in place, although it is extremely important. It would limit our flexibility to respond as necessary to situations that call for a change to the current processes we have in place. I therefore urge the noble Lords to withdraw the amendment.