Welfare Reform Bill

My Lords, I begin by following the very proper example of the noble Lord, Lord Low, and apologise to the Committee for not participating in its debates until day 13. I have attended a number of sessions and amendments are down in my name and other colleagues’ names and have been down for some time but other commitments in the House have prevented me being here. I do not show any disrespect to the hard work this Committee has done because of that. The noble Baroness, Lady Grey-Thompson, in her Amendment 86ZZZUA makes a very important point. She is seeking to amend Clause 78 entitled, ““Ability to carry out daily living activities or mobility activities””. It makes commonsense for anyone doing that also to seek to collect evidence from the claimant’s own medical healthcare professionals. I hope the Government will certainly see that. The noble Lord, Lord Addington, very ably put the case for his Amendment 86ZZA which I and others have supported. It expresses concern about people who will carry out assessments having the right and proper qualifications. In making legislation we must learn the lessons of what we have done before and the noble Lord, Lord Addington, referred to it. My party when in government in 2008 introduced the work capability assessment as part of the employment and support allowance. It has been flawed. It has been shown that—the noble Lord just has made this point— 40 per cent of those who appeal against decisions have had their appeal upheld. Clearly there is a problem. It is important to have proper qualified people to carry out assessments. Indeed, Professor Harrington, in his report, recommended that there be mental, intellectual and cognitive champions in each medical assessment centre to support professionals in assessing those with such disabilities. Again, that makes sense. I shall give two brief anecdotes to the Committee, if I may, from my time in the other place. On one occasion a family came to see me. They had been on holiday and their daughter, a young woman, was staying with an aunt in the same street a couple of houses away. She went home one morning to collect the post only to find a man sitting in a car outside the house. He got out saying that he was Dr So-and-So who had come to assess whether she was still entitled to benefits. The young woman protested; she knew nothing about it. He insisted on coming into the House to carry out an assessment of her, resulting in her benefit being stopped. This young woman was in a wheelchair and had been disabled from birth. The point I am making is that sometimes there is such a casual approach even under the present system to these assessments that I am worried that if we do not have properly qualified people, we will not get proper and fair results in future assessments. In the other case, a woman came to see me whose benefit had been stopped. I listened to her arguments, read the papers, and so on. I thought this was unjust and took up her case. After about two months I was getting nowhere. I wrote back and forth and eventually asked for all the documents that the assessor completed when the assessment to remove her benefit was done. At the top of the first page on the right-hand side, the assessor had written ““Wore a fish badge, probably a Christian””. I am not saying that that had any impact on the assessment but what was going through that chap’s mind when he carried out the assessment? Indeed, when I went back to the department they were so concerned that they did not want any bad publicity and the benefit was restored. My point is that sometimes the casual way in which those assessments are done is detrimental. We must ensure that people have proper assessments. The purpose of Amendments 86ZA and 86ZB in my name, that of my noble friend Lady Healy of Primrose Hill, my noble colleague and fellow countryman, the noble Lord, Lord Wigley, and the noble Baroness, Lady Gardner of Parkes, are to ensure that claimants are not put through a face-to-face assessment where it is possible to determine the question of a claimant’s entitlement to a benefit on the basis of available, medical and social assessment evidence. That approach will not only save a great deal of money but would avoid placing undue stress on claimants with a disability or a significant illness. I understand that the Government have estimated the cost of implementing the changes to DLA, including the new assessment regime, in the region of about £675 million. They plan to reassess all current recipients of DLA as part of the move to PIP and PIP claimants will also be reassessed regularly. The National Autistic Society has raised specific concerns about the introduction of face-to-face assessments for the new benefit, particularly given the experience of the work capability assessment to which I have already referred. When the educational support allowance was first introduced in 2008 the National Autistic Society followed a group with autism through the work capability assessment process and identified that the medical assessment was a particular barrier to fully assessing need. Many people reported that the Atos doctors undertaking the assessment did not have a full understanding of people with autism. I share the NAS belief that face-to-face assessments are not necessarily an appropriate way to assess the needs of people with autism because of the nature of their condition and associated difficulties that many have with communication. Last Wednesday I was in Nottingham attending the annual meeting of the National Autistic Society. The question of replacing DLA with PIP and the worry about face-to-face assessments were on the minds of a lot of people there. I spoke to people about the problems this would cause for their autistic sons and daughters. If anyone needs to understand what autism is, I would start with four words: autism is for life. It is as simple as that. I repeat, autism is for life. One of the founders of the National Autistic Society, Lorna Wing, said, ““When you have seen one person with autism, you have seen one person with autism””. That is important to understand because the autism spectrum is such that no two cases are the same. If there was one message that I would bring to this Committee from the people to whom I spoke in Nottingham, it is simply that they hope that the Government will examine in more detail proposals to amend the assessment process. They want to see a regime that properly takes into account the reality that at the heart of autism lies the difficulty to communicate effectively and to possess an awareness of one’s own difficulties and needs. These past months, in seeking to learn more about the problems of people with autism and those who care for them, I have spoken to countless people who have told me that on facing an interview, if they were able to do so, their son or daughter would practise their responses to the questions. Others told me of similar circumstances when their son or daughter would give answers that did not accurately reflect their situation, whether due to lack of their own insight or their condition. They simply wanted to answer the question to please the questioner. That really happens. The information provided to noble Lords for today’s debate by the National Autistic Society emphases some of those points. The briefing tells us that when one claimant with autism was asked, ““Can you travel independently?””, he replied that he could. In fact, his support worker had travelled with him every day for the previous six months in order for him to complete a simple bus journey to the local shops. The individual was unable to understand that the real meaning of the question was whether he could independently travel to new places without support. Many people with autism take language literally. This individual felt that he had achieved that. He believed that his answer covered the whole question being put to him, but which he did not fully understand. This has been my experience of talking to people with autism and their families. Last week, I met two chaps with Asperger’s who were not diagnosed until they were 40 years old. When one sees the problems and difficulties that these people have, we must ensure that any assessment is right, proper and fair. Given the complexity of autism and the lack of knowledge of the condition among professionals, it is vital that any decision about the allocation of benefit takes into account any expert assessment of an individual—a point ably made by the noble Lord, Lord Addington. I agree with the National Autistic Society when it says that it, "““would not expect every medical professional to have a specialist understanding of autism, so where expert reports are available, they must be used””." Of course they should. It continues: "““Expert reports will be much more comprehensive than any assessment made by a benefits assessor is ever likely to be. In instances, where a detailed report of need, carried out by a specialist is available, we would question the value of a face to face assessment with someone who does not have this expertise””," and therefore cannot give a proper and fair response in evaluating a person’s condition. The NAS goes on to say: "““The face to face assessment will add unnecessary anxiety to the individual, who has probably … been subject to numerous assessments and tests. It also makes the process more costly at a time where finances are increasingly””," difficult, as we hear from Ministers all the time. The Disability Benefits Consortium has rightly argued that people who are severely ill or disabled and suffering from a progressive illness or condition should not be subjected to the stress of a reassessment. The National Autistic Society has taken a similar view and is arguing for a tiered approach to the new assessment process. A paper-based assessment, including self-assessment and expert reports, would constitute a first tier to the assessment process. If a person’s needs can be demonstrated without them having to attend a face-to-face assessment, carrying these out as a matter of routine will save unnecessary expense. If need has not been sufficiently demonstrated through the process, it would be at this point that a face-to-face assessment could be introduced. Currently, a large majority of DLA decisions are made on the basis of paper evidence. Earlier today, the noble Countess, Lady Mar, made the point that just 1 per cent of these cases are said to have been brought about by fraud. We can be certain that that is not a headline we will see in the newspapers. Surely it is an inefficient use of resources to undertake face-to-face assessments and reassessments of people who have been diagnosed by medical or social care professionals as having a condition that either is unlikely to change significantly or that will certainly, by the nature of the condition, deteriorate over time. On the positive side, I welcome the Minister’s recent indications—I think at Second Reading, but he will correct me if I am wrong—that he felt that in some circumstances the face-to-face assessment might be counterproductive. He noted that a number of Peers had worried about autism and how it would be handled, and stated that where it is, "““not realistic, helpful or appropriate””," the Government will not insist on applicants for PIP being seen face to face. Amendments 86ZA and 86ZB seek to do just that. They would secure two key objectives that I feel the Minister would be willing to embrace. They would put safeguards in the Bill so that those who have sufficient written evidence to demonstrate their needs do not have to go through a face-to-face assessment unnecessarily. As a result, the Bill would provide that all assessments will take into account expert reports and evidence as a first-tier assessment. This is our chance to ensure a fairer and more reasonable application of the new proposal that the Government are bringing forward. I hope that the Minister will take it on board.