Welfare Reform Bill

My Lords, this is a very important debate. I support the idea of keeping the qualifying period for PIP at three months. I also hope this debate will look at the idea of the prospective period moving from six to nine months if the Minister sees that as an appropriate practical way of dealing with the Government’s intention to align the qualification period for PIP with the Equality Act, as I understand it. I, like many, am extremely concerned that the proposals here will have a devastating impact on disabled people, especially those with sudden-onset conditions such as cancer. Cancer patients often see sudden changes in their household income combined with significant cost escalation on diagnosis. This can make cancer patients particularly vulnerable to financial difficulties and in need of immediate financial support. Why do people with sudden-onset conditions need support immediately? We know that cancer treatment and its debilitating effects can often begin very quickly after diagnosis, as the noble Baroness, Lady Thomas, has already explained. The associated support needs arising from that treatment are often immediate and, importantly, the first six months can be the period when extra costs are at their greatest as people try to adjust their outgoings to their reduced income. Research by Macmillan found that 80 per cent of cancer patients who experienced increased costs reported that they were greatest in the first six months. Having to wait for three months under the current disability living allowance is already difficult for people with cancer. Doubling this to six months under PIP will be devastating. Seventy per cent of cancer patients’ households suffer loss of income and/or increased cost as a direct result of their cancer. Without support for the additional costs, which are faced immediately following the sudden onset of a physical or mental condition, people will face increased debt and difficulty in managing debts that they may already have. There are cases of house repossession and real hardship. What are people’s needs, which can be so pronounced, in the first six months following a cancer diagnosis? We have heard about the cost of travel, including parking costs for hospital appointments. That is an obvious one. Nearly half of all cancer patients face increased travel costs and around 41 per cent face increased hospital parking costs following diagnosis, as Macmillan’s research has shown. On average, someone with cancer makes 53 trips to hospital, so that is not an avoidable cost. Children and young people, who will have their treatment at one or more of the 19 specialist principal treatment centres in the UK, have an average round trip of 60 miles. Low immunity often forces patients to rely on taxis rather than use public transport. I will say more about that in a moment. New clothes are another additional cost. That may sound like a trivial point but it is not for many people with cancer. They can experience dramatic weight loss or weight gain. One cancer patient told Macmillan that, "““some clothes hurt my chest if I wear them … I wear t-shirts or pullovers instead, even on the occasions I’m wearing my sari””." There are extra costs because of fuel. I am advised that this takes two forms: the increased need for heating and the increased need for the use of appliances such as washing machines—due to profuse sweating and hygiene requirements—and dishwashers. So there are increases to fuel bills in addition to the ones that everyone knows about anyway. One cancer patient explained to Macmillan that, "““because I cannot reach the washing line since having surgery I have to tumble dry the washing””." That is a very basic problem to have to deal with. Seventy-three per cent of cancer patients who are undergoing active treatment use more fuel than they did previously. Then there is the question of aids and adaptations such as wigs, shoe inserts and special diets, which I shall mention again in a minute. People experience real costs following diagnosis. It has been suggested that people with cancer might have access to other sources of income and support. This is not always the case and we cannot assume it. Some people with cancer will not have the access to alternative sources of the financial support that they need for the first six months of their condition. For many, this will result in real financial difficulty, so we cannot assume that that will cover the problem. Extending the qualifying period will also have an impact on debt and financial problems, which we already know are real for many people. That needs to be taken into account. Therefore, I want to ask the Minister what assessment the Government have made of the likely impact of extending the qualifying period to six months on the likelihood of more disabled people falling into debt and poverty. We have heard about the impact of extending the qualifying period from the point of view of those with intermittent conditions and so on. We have heard many personal stories in this Committee. While Macmillan gave me some very good case studies, I thought it would be most interesting to share my recent experience, which came from my niece, who in April 2010 was diagnosed with grade 4 Hodgkin’s lymphoma following a very sudden and serious illness. She immediately experienced severe weight loss and loss of appetite because of the disease process playing havoc with her normal taste. She had terrible issues with night sweats, which brought with them all the costs of buying new clothes and bedding and using an awful lot of fuel, as I have mentioned, to deal with the daily washing of bedding. Then there was the impact of a neutropenic diet caused by the effects of heavy-duty chemotherapy. There was the cost of having to buy pre-prepared foods, involving fickle choices over what was or was not possible to eat. She could not prepare meals because she was too weak to stand and cook, but she was fiercely independent and not at all easy to help. Following on from that, there is the susceptibility to infection caused by the very important but aggressive treatment; not being able to use public transport; not being able to drive because of fatigue. All of this happened in the first couple of months following diagnosis. She had to attend hospital two or three times a week and had radiotherapy at three months, every day for a month. Now, 18 months on, she is still having chemotherapy and, after a failed stem cell transplant and a number of novel antibody treatments, she is now preparing for a second transplant, but her spirits are very good. She said to me that DLA was absolutely vital to her coping early on, following her diagnosis, because of the huge additional costs that she experienced, but particularly because of the mobility component that she accessed. That gave her a blue badge, a congestion charge exemption, a car tax exemption, a taxi card and a disabled travelcard. All that because of DLA. That in itself was able to save her hundreds of pounds a month in taxi fares. I have talked about my personal experience; others, I am sure, have their own personal experiences of why it is so important that the DLA qualification period should not be extended. I want to understand better than I do now what the rationale is regarding the Equality Act because we know from that Act that people with cancer are deemed to be disabled at the point of diagnosis. If the whole drive here is to align with the Equality Act, then that does not quite fit. I am not suggesting that we would expect people with cancer to be able to access PIP at the point of diagnosis, but I do not see how that rationale works here. I look forward to the Minister’s response.